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The Medical Casebook of Adolf Hitler

The Medical Casebook of Adolf Hitler - Leonard L. Heston, Renate Heston Waste. Of. Time.Just like the title says, this is a detailed analysis of Hitler’s medical records. That’s it. When the Allies took Berlin in April 1945, they found several hundred pages of notes by Hitler’s personal physician (Dr. Theo Morrell) in the bunker complex where "Der Führer" committed suicide. The records found their way to the National Archives outside Washington DC, and in the late 1970’s authors Dr. & Mrs. Heston sifted through them to give a complete picture of Hitler’s health from 1938 to 1945. The two big questions I had going in were answered pretty quickly:Q: Is there anything in Hitler’s medical records to help explain the evil policies he enacted ?A: NO. Evil remains outside the scope of medical science. If anybody out there was thinking of an insanity plea to excuse Hitler's actions, they will be disappointed. While his behavior was at times erratic, impulsive, capricious, and irrational, he did not fit any criteria for medically-recognized psychosis. He knew what he was doing. Q: Hitler’s biggest blunder of the war was the June 1940 decision to double-cross Joseph Stalin and launch a surprise attack against the Soviet Union, before securing the Western front (i.e. taking Great Britain.) This created a two-front war, which Germany was unable to sustain. Is there anything in Hitler’s medical circumstances at the time which could account for this lapse in judgment?A: NO.From the mid 1930’s on, Hitler was sporadically taking opiate painkillers for an ill-defined gastrointestinal disorder which sounds variously like it may have been biliary colic, perhaps a duodenal ulcer, or less likely chronic pancreatitis. He had a single episode of jaundice, which may well be related to biliary obstruction, but unfortunately no lab tests can be found to support this. Hepatitis can also not be excluded. Hitler was unaware, but Dr. Morrell was also giving him a mild dose of amphetamines, which he called “vitamins”. (Hitler became a vocal supporter of vitamins!) Over the years, his dosage increased and became more frequent, so it is likely he was becoming addicted, but by all accounts, his judgment in June 1940 was as good as it had ever been. As the war progressed, as he became more chronically fatigued, more frequently and severely stressed by his military and political situation, as he became more suspicious of those around him (following an assassination attempt in 1942), Hitler’s judgment did noticeably decline, but most sources agree his capacities were not significantly diminished until mid-1942. So what’s left? The rest of the book is not very different from reading any 50-something year old’s medical records. Hitler’s health was not great. He had a progressively worsening tremor in his arm, which is not conclusive, but suggests the early presentation of Parkinson’s Disease. Observing film clips of him walking show a mild gait abnormality (slightly dragging left leg) which seems nonspecific, but may also be part of Parkinson’s.He had a benign polyp removed from a vocal cord- a trivial diagnosis which is not surprising, given the amount of public speaking Hitler was known to do. As so many men do in their 50's, Hitler had borderline hypertension and moderate to severe coronary atherosclerosis (diminishing of the heart muscle’s blood supply, due to the formation of cholesterol-laden plaques within the major blood vessels). EKG records strongly suggest he had a minor heart attack sometime in 1943 or 1944. Morrell’s notes, corroborated with witness accounts, describe an incident lasting several days in February 1945, in which Hitler suffered a sort of collapse of reason. Morrell attributes this to stroke (i.e. Cerebral Vascular Accident), but of course no imaging studies exist, and no detailed neurologic exam is documented. Hitler’s rapid and complete recovery seem to contradict this diagnosis, although a TIE (i.e. transient ischemic event) may have occurred. A few other minor tidbits: occasional insomnia (seriously, who hasn’t had this?), some headaches (again…), a minor shoulder injury sustained in 1931 (completely recovered), some wounds sustained in WWI: bits of shrapnel in the left thigh, temporary blindness due to mustard gas (a common effect, completely resolved in a few days). A few details about Dr. Morrell: not exactly a great physician. Hitler found him on the recommendation of his personal photographer (!), and apparently didn’t look too carefully into Morrell’s practice. He wasn’t quite a quack, but as so many bon vivant physicians are wont to do, Morrell had the habit of never treating anybody who was seriously sick. He mainly treated minor skin conditions and venereal disease. If one of his patients showed signs of developing anything more serious, that person’s care was immediately transferred to a specialist. It wasn’t that Morrell was incompetent; he just never handled any remotely challenging cases. It was only through Hitler’s insularity and medical ignorance, and not Morrell’s skill or professional reputation, that he [Morrell] rose to become responsible for the care and well-being of the most powerful man in the country. On April 30, 1945, Hitler and Eva Braun committed suicide. According to witnesses, their bodies were doused in gasoline and set on fire. No hard evidence exists to show Hitler’s remains were ever recovered and positively identified. The area where he was supposed to have died fell under Soviet control, when Berlin was divided up after the war. In 1965, Soviets published accounts of an autopsy on charred remains of a body whose dental records match Hitler’s. This is suspect, because the Soviets have been unwilling to share said dental records. It is difficult to judge how much- if any- of the report is true, because nobody knows to what extent Hitler’s body was supposed to have been burned. The Soviet autopsy report omits any mention of the liver or gallbladder, which is too bad, because the cause of Hitler’s abdominal pain was likely chronic calculous cholecystitis. That reminds me of a funny story I will hide here in the spoilers One of the first autopsies I ever did, I forgot to document the appendix. I was still just learning dissection technique, and I was a bit unorganized, and I just didn’t write anything down about it. To teach me a lesson, my mentor made me go back through the organ bucket (where organs are stored after autopsy) to find it. I spent like two hours going through all the tissue pieces floating in that bucket, and I couldn’t find the damn thing. I finally returned to my mentor’s office, and he started laughing at me. He had read the patient’s record, and knew the patient had an appendectomy like 30 years prior. He had just made me go back through all the organs to drive home the point that I should have noted and documented the surgical absence of appendix. Haha- bastard! The Soviet report says Hitler was monorchid (only had one descended testicle), which is entirely possible, but seems like something Morrell would have known and documented. It is also possible that this bit of information is fabricated to be an embarrassing slur on Hitler’s manhood. Testes, because of their external location, are particularly vulnerable to being completely destroyed if any significant amount of burning occurred to the body.There is an overly-long chapter about amphetamines.There is a decent but long chapter about differential diagnosis vs. working diagnosis, diagnostic certainty and preponderance of evidence, etc. It is a fairly good description of the diagnostic process. This book may be of interest as historical trivia, or to dispel any stories that Hitler was insane, but the real take-home message of this book for me was that all of Hitler’s monomania can be explained by non-medical reasons. He set out to exterminate the Jews and other targeted groups because of a hatred he learned towards them in his early adulthood, and because it was politically expedient. He made some poor military decisions because he lacked much formal military training. He was a low-ranked soldier in WWI for a few years, and he taught himself some additional things by reading, but he was hardly an academy-trained Field Marshal, which is what he set himself up to be in terms of conducting the war. His political and military misjudgments became worse and more frequent as his power increased… most likely reflecting the fact that he became increasingly surrounded by subordinates who either couldn’t or wouldn’t contradict him. The medical information in this book is mildly interesting, but none of it explains the important historical or [a]moral aspects of the man.