The Dark Legacy of Dr Hans Asperger: Autism, Nazism, and Medical Complicity

Austrian paediatrician Dr Hans Asperger, a pioneer in the field of child psychiatry and a researcher into childhood autism, was for many years portrayed as an opponent of the Nazi regime under which he worked. When the aberrant behaviour of ‘maladjusted’ children became controversial in the Third Reich, the Asperger Department of the Paediatric Clinic in Vienna worked to develop them. Asperger, who, in his own words, was said to value the unique characters of children, tailored his holistic approach to their individual needs, believing that ‘with proper understanding, love and guidance, they can find their place in the organism of the social community’.

Dr Asperger’s long-standing friendly image, with his tall stature bending down to connect with children at their level, represents just one side of the doctor’s work. Historian Herwig Czech spent eight years studying unexplored archival records, key among them Asperger’s analyses of patient files mistakenly thought to have been destroyed, and in 2018 revealed that, contrary to his compassionate image, Hans Asperger was a well-adapted cog in the machine of the Nazi death regime.

Asperger offered intensive and individualised treatment to children “with mental health problems”, whom he considered “reparable” and teachable, and who had the potential for social integration. However, he was dismissive of those he considered to have a more severe disorder, prescribing strict institutionalisation or even transfer to the Am Spiegelgrund clinic.

At this notorious clinic, which operated within the Steinhof psychiatric hospital in Vienna, children with disabilities and mental disabilities were abused for research purposes and at least 789 were murdered by poisoning or by prolonged administration of barbiturates; the documentation listed the cause of death of the children as ‘pneumonia’.

In the Third Reich, reluctant statements could be a death sentence and some Asperger’s assessments actually led to death.

Documents discovered over a decade ago reveal that Dr Asperger referred dozens of children who did not meet the Nazi regime’s criteria to the Am Spiegelgrund children’s euthanasia clinic, even though he knew that they would be subjected to cruel experiments and would probably be euthanised under the Nazi programme known as ‘Aktion T4’.

In 2018, Herwig Czech, a medical history researcher from the National Socialist era, published his findings on Hans Asperger’s involvement in the Nazi regime and the euthanasia programme, in which around 300,000 people were executed during World War II, in the peer-reviewed medical journal Molecular Autism.

Asperger managed to adapt to the Nazi regime and was rewarded with career opportunities for his declarations of loyalty. He joined a number of organisations affiliated to the Nazi Party, but kept his distance from National Socialism and never joined the NSDAP. He publicly advocated a policy of racial hygiene, including forced sterilisations, and on several occasions took an active part in the child euthanasia programme.

The language he used to diagnose his patients was often extremely harsh, even compared with the assessments written by the staff of the notorious Am Spiegelgrund clinic, disproving the notion that Asperger was trying to protect the children in his care by embellishing their diagnoses. He labelled children with terms such as “unbearable burden”, “polymbecilic” or “psychopathic baby”.

One boy with symptoms of hypochondria was sent to a forced labour camp as a ‘cure’. He also made unnecessary references to the Jewish origin of his patients, which was extremely dangerous and potentially fatal information.

The ambivalence of Asperger’s actions underlines the duplicity of Nazism as a whole. The Raj’s project of transforming humanity involved both healing and elimination. Given the failures, some individuals could be trained to fit Nazi standards, but many had to be eradicated.

Asperger’s role during the Nazi era was unknown until the discovery of archival documents. Czech’s work details, among other things, Asperger’s work on the Vienna Commission for the Assessment of Children’s ‘Educational Capacity’, where he acted as a medical adviser.

Thirty-five children, classified as “hopeless”, were transferred to Am Spiegelgrund and not a single one survived. Czech considers it impossible that Asperger knew nothing about what was happening there, but the question of his personal adherence to Nazi ideology remains unclear, particularly because of his Catholic religious convictions.

The discovery of autism

Autism is a lifelong developmental disorder that affects the brain’s ability to process information. Due to the variety of forms and varying degrees of severity, the disorder is referred to as Autism Spectrum Disorder (ASD), but is also known as Spectrum Autistic Disorder (SAM).

According to the RehaMedicAL website, autism is characterised by a unique pattern of behaviour, dependence on routine, sensory sensitivity and impaired sensory perception. People with autism are often disturbed by noise, certain smells and touch. They may hurt themselves, grope, bite objects and clothes, throw things, and have impaired motor skills due to poor perception of their own body.

Autism spectrum disorders also involve restricted and repetitive patterns of behaviour. The term ‘spectrum’ in autism spectrum disorders refers to a wide range of symptoms and their severity. ASDs include conditions that were previously considered separate – autism, Asperger’s syndrome, Rett syndrome and Pervasive Developmental Disorder Unspecified – but all international diagnostic classifications are slowly phasing out the individual subgroups.

Each child with an autism spectrum disorder has a unique pattern of behaviour and level of severity – from high-functioning (including Asperger’s syndrome) to low-functioning; this includes the one-third of autism spectrum disorders where there is an associated intellectual disability. The main areas of deficit and deviance seen in children with ASD are referred to as the ‘triad of deficits’. These are difficulties with social interaction, difficulties with communication and difficulties in the area of flexible thinking. The aetiology of autism is still not entirely clear.

The term autism was coined in 1911 by Eugen Bleuler, a Swiss psychiatrist, to describe schizophrenic patients who appeared to be detached from the outside world.

Hans Asperger and his Austrian-born colleague Leo Kanner were the first doctors to use the term autism as a stand-alone diagnosis to describe some of the characteristics of social withdrawal; others described similar children, but called them schizoids.

Kanner, who emigrated to the USA in 1924 to work at Johns Hopkins Hospital and became a pioneer of American child psychiatry, published a study on autism in 1943 entitled ‘Autistic Affective Contact Disorder’, in which he described a specific pattern of abnormal behaviour he had found in 11 children.

They were characterised by an absence of eye contact, an inability to relate appropriately to other people, difficulties in communicating and expressing emotions, and an obsessive desire for sameness. The children were often excessively frightened by ordinary things and maniacally interested in a particular thing. They showed resistance to change and most children also had eating disorders.

Most of these children came from the upper economic strata and their parents were highly intelligent, so Kanner mistakenly believed that this was a disorder of children from the higher educational and economic strata. He correctly observed that autism is more common in boys. He also believed that the disorder was caused by ‘obsessive’ parents who paid too much attention to trifles, and he wrote about ’emotionally cold mothers’ who were said to impair the child’s ability to make social contact. Subsequent studies have shown that autism is not caused by bad parenting.

Kanner’s description of a specific pattern of abnormal behaviour is now known as early childhood autism.

In Vienna, independently of Kanner, a year later Hans Asperger used the word autism to describe more intelligent and functional children who did not fit Kanner’s description of classical autism. Asperger’s definition of “autistic psychopathy” was much broader and included children with milder problems that appeared later, often only during the school years.

Communication problems were generally absent, although they did not recognise body language and their intellectual abilities were average or even above average. Asperger’s cited their social ineptitude and pattern of restricted, repetitive behaviour. He also observed physical clumsiness in autistic psychopaths.

Asperger’s studies were little known for decades until leading British psychiatrist Lorna Wing discovered his theses in 1944 and accelerated the understanding of autism worldwide. In 1981, she published an academic paper popularising Hans Asperger’s research and coined the term “Asperger’s Syndrome” in recognition of his outstanding contribution to the conceptualisation of the condition.

The idea became established in psychiatric circles and Asperger’s syndrome became a diagnosis in its own right at international level.

Over the years, many psychiatrists have become increasingly interested in children who are thought to be isolated from the world around them and have developed different terms to classify them, but the understanding of the disorder has changed considerably on the basis of empirical research.

Eighty years ago, Kanner wrote that “although autism is a rare disorder, it is probably more common than the number of children observed suggests”. The incidence of autism is on the epidemiological rise both in this country and worldwide. Whereas in 1996 one in 1 000 people had autism, now one in 50 is diagnosed with an autism spectrum disorder.

Asperger’s youth and “red” Vienna

Asperger was born on 18 February 1906 in the heart of the Habsburg Empire, in Hausbrunn in north-eastern Austria, close to the borders with Slovakia to the east and the Czech Republic to the north, fifty kilometres from Vienna. He was the eldest of three children. His middle sibling died after birth, and his younger brother Karl, four years younger, was killed in the Soviet Union during the Second World War.

Asperger said that he was brought up “with great love, in fact, the sacrifice of my mother and the great strictness of my father”. His father, Johann Asperger, who came from a long line of farmers, was never able to realise his dream of becoming an accountant, so he made strict demands on his son in order to realise his shattered dream through him.

Although Hans lived up to his father’s high expectations, later in life he did not approve of strict parenting. “I was not like that with my children or with any of my patients,” he later reflected.

The young Asperger was a voracious reader with a special talent for languages, literature, classics, history and art. He once said that he had collected ten thousand books in his home library. This voracious reading, he claimed, had led him to a “gradual spiritual maturity”.

The German youth movement, which brought Asperger out of the strict home and school environment and into outdoor boys’ groups, also had a kind of spiritual influence. Asperger was a devout Catholic, which was often cited as an argument for his innocence during the war.

In Czech’s view, this is misleading. Although Asperger never joined the Nazi Party, he was a member of several Nazi organisations. He enjoyed hiking and mountaineering with members of the Bund Neuland, an ultra-nationalist Catholic youth association with anti-Semitic tendencies, which he supported throughout his life.

He went on long hikes, often writing down his thoughts in small notebooks. He even met his wife Hanna Kalmon, with whom he had five children, while hiking.

In 1925, at the age of 19, he left his small hometown with great ambitions to study medicine at the University of Vienna, where he experienced and was shaped by a turbulent metropolis undergoing enormous change. After its defeat in the First World War, the city became a cauldron of social upheaval, political strife and economic disaster.

Vienna was the only European city of more than a million inhabitants to elect a socialist government. This earned the city the nickname “Red Vienna”. In order to educate its citizens for a new socialist society, the Vienna city administration launched a vast and bold experiment in public welfare, based on eugenics.

Eugenics promised that the disorders of modern society could be overcome through rational programmes and planning, and was the basis for the emerging welfare systems in Europe and the USA. The Viennese system was admired as one of the most advanced social welfare programmes in Europe, but the state was increasingly intruding into the private lives of its citizens, both in reproduction and in child-rearing.

It was given increasing powers to determine what was normal for children and their homes. If something seemed wrong, children could be removed from their families, placed in foster care, placed in a children’s home or locked up in a “reformatory”.

Although many child development workers were well-meaning, the conditions in state-run homes were dire, often abusive. Children suffered hunger or neglect, even when they were not exposed to violence by their caregivers or other youth.

State authorities had breathtaking power to shape the lives of children and their families. By 1936, an average of twenty-one children a day were removed from their families and sent to one of Vienna’s child welfare services. State intervention could help children, but it could also disastrously harm them as Austria slipped into fascism and the Third Reich.

Early career and Nazi criteria

In 1911, the paediatrician Erwin Lazar founded the Heilpädagogische Station (Department for Curative or Curative Education – the term is synonymous with special pedagogy in German) at the University Children’s Clinic in Vienna, which, under the leadership of its director, Clemens von Pirquet, achieved international renown. The mission of the Department of Curriculum Education, which combined pedagogy, psychology and medicine, was to socialise children with behavioural, mental, psychological, physical and language disorders through appropriate educational and therapeutic services.

Lazar’s vision of curative education is somewhat difficult to translate, so there are different options: therapeutic pedagogy, remedial education or special education. Curriculum education was perfectly in line with the Viennese multidisciplinary approach to social work and became a central part of it.

Schools, social welfare offices and courts sent problem children to the Lazar Clinic, and the staff made recommendations for their treatment, institutionalisation or detention.

When Franz Hamburger, a great advocate of racial hygiene, was appointed head in 1930, the University Paediatric Clinic became a leading institution of anti-Jewish policy long before the Nazi takeover.

Hostility towards female employees also played a role. The Austro-Fascist regime was keen to push women out of the labour market, a cause also advocated by Nazi ideologues such as Hamburger, who soon introduced radical changes at the clinic. He replaced Pirquet’s former colleagues, many of whom were Jewish, with doctors who were fervent Nazis.

The exception was twenty-five-year-old Hans Asperger. Hamburger’s student, who had just finished his medical studies, got his first job as an auxiliary doctor in 1931. Although he had not yet qualified as a specialist paediatrician, his very rapid rise to the head of the paediatric department in 1935, despite the existence of more qualified candidates, was made possible by the anti-Jewish policy.

Austria was at that time the scene of severe anti-Jewish violence, and Jewish doctors had increasing difficulty in obtaining university positions, with some clinics virtually closed to Jews.

Asperger repeatedly praised his mentor for shaping his view of medicine and remained loyal to him in the post-war period, even after Hamburger was discredited. Although Asperger did not join the Nazis, he had many ideological commonalities with Hamburger and his network, which allowed him to fit in without apparent friction.

Among Asperger’s associates was Erwin Jekelius, who was engaged to Hitler’s sister Paula and was the most prominent figure in the euthanasia of children and adults in Vienna, later responsible for the deaths of thousands of psychiatric patients and mentally handicapped children.

The Nazi state’s aim was to create a spiritually united, strong and racially pure German Volk, and this meant raising children who would feel a sense of national belonging and who would be devoted to the regime, steadfast and physically superior. When the Nazi regime came to power in 1933, it began to control education. Children were organised into youth organisations and taught total devotion to the national community.

Nazi child psychiatrists, such as Asperger’s, had to diagnose the child’s character according to the regime’s norms. Children who did not meet the Nazi criteria – in mind, body and spirit – could face a number of labels. While the ideals multiplied, so did the definitions of defects.

As belonging to the Volk became a priority in the Third Reich, Nazi child psychiatrists increasingly observed children who were considered to have weaker social bonds and did not fit in with the group. As a result of this new paradigm, many doctors developed diagnoses for children who were not connected to the community and which were similar to Asperger’s definition of autistic psychopathy.

Nazi child psychiatrists used the term Gemüt to express their ideas about social sense. It was one of the untranslatable words of the German language, denoting the fundamental ability of an individual to form deep bonds with other people. A good Gemüt was essential for the human being as an individual and for the health of the Volk.

Testing ideological suitability

New standards – racial, political and biological – emerged for entry into the national community. There were also new standards of mind – children had to be able to adapt and blend into the collective.

Asperger, in the very first sentence of his 1938 lecture on autistic psychopathy, hailed the Reich’s grandiose ambition to transform society. He observed how his Reich colleagues were charting the deadly course of Nazi psychiatry. Soon he was involved in programmes that made their terrifying visions a reality.

Although Asperger was not a Nazi sympathiser, he seems to have worked to the limit to make himself look like a Nazi. He included pro-Reich rhetoric in his documents and accommodated himself to small details, such as signing documents with Heil Hitler, even when it was not necessary.

His religiosity aroused some doubts among Nazi Party officials, who considered religion in the Third Reich incompatible with and even threatening to Nazi ideology. The regime persecuted and imprisoned priests, desecrated churches and pressured citizens to stop religious rituals.

One letter from the SS in Asperger’s party file expressed concern that “Dr Asperger is firmly clerical”. National Socialist officials soon concluded that his Catholicism did not affect his political confidence and that he was “a devout Catholic, but without the political leanings that accompany Catholicism.”

Asperger was also reliable in the field of Nazi racial hygiene. In a November 1940 Party assessment, an SS major assured that Asperger “never actively worked against the Nazis, although in a children’s hospital – staffed only by National Socialist doctors – he could easily have obtained material for a denunciation.”

The possibilities for “exposure” were numerous: sterilisation of children, medical experiments on children, and the euthanasia programme for children in the Spiegelgrund, which had just begun.

In Vienna, the efficiency of the killing of adults, which began in 1939, literally opened the way to the killing of children.

When the staff of the Steinhof psychiatric sanatorium deported 3 200 patients to an ‘unnamed institution’ in the Reich in the summer of 1940, where they were murdered as part of the T4 campaign, they emptied enough space to accommodate hundreds of children who did not meet the regime’s criteria of ‘hereditary suitability’ and ‘racial purity’.

In July 1940, the Vienna Municipal Youth Welfare Institution Spiegelgrund was set up on the Spiegelgrund on the west side of Steinhof’s sixty pavilions, hidden behind brick walls and comprising nine two-storey pavilions with a capacity of 640 beds. Building No 17 was the children’s death observation pavilion, and pavilion No 15 housed the killing centre.

The killings in the Spiegelgrund began on 25 August 1940. At least 789 children died there during the Third Reich, with pneumonia being the official cause of death for almost three-quarters of them. This was supposed to be a natural cause of death, but was in fact the result of the staff issuing barbiturates with the intention of killing. The children then lost weight, got fevers and were susceptible to infections, which usually ended in pneumonia. Many other illnesses could also cause death as a result of untreated illnesses and malnutrition.

In post-war interrogations, former Spiegelgrund doctors testified that it took time to perfect killing methods. Death sometimes occurred within a few hours or only after a few days.

Under the supervision of Ernst Illing, who succeeded Jekelius as director in 1942, the children were usually given Luminal or Veronal tablets, which were powdered and usually mixed with cocoa so that they did not taste bad. “But when a child was in the process of dying, they could no longer rely on swallowing, but had to be injected with barbiturates,” Illing recalled.

Spiegelgrund staff often referred to the parents’ desire to get rid of their children and explicitly stressed the benefits of death. But the real purpose of the child euthanasia programme was not to make life easier for parents, but to purge the Reich of unwanted citizens.

In the 1940s, practical skills and “educational ability”” became the decisive criteria for deciding on measures of racial hygiene. It is important to note that Asperger focused on skills, while others were mainly concerned with faults.

Asperger had already captured the central tenets of Nazi medicine in an article a year earlier, writing that it was necessary to ensure that patients who would pass on their illnesses to distant generations to the detriment of the individual and the Volk were prevented from passing on their hereditary disease material, indicating that he was willing to cooperate with the Nazi state and propagate – albeit less enthusiastically than others – the elements of Nazi racial hygiene. He was convinced that curative education could turn troublesome or ‘abnormal’ children into useful members of society. However, his pedagogical optimism reached its limits in the case of children with a higher degree of mental disability.

Although he usually dealt with the more promising cases in his department, in the course of his varied activities as an expert on “abnormal” children he also encountered children for whom the Nazi state had in mind nothing more than discreet medicalised destruction.

Children at the lower end of the spectrum did not benefit from the potential attributed to those at the upper end, even though they shared the common diagnosis of ‘autistic psychopathy’. Their fate depended not on the diagnostic label but on an individual assessment of their abilities or impairments.

During the Nazi era, ‘uneducability’ became a key criterion in the child euthanasia programme, and the task of curative education was often to decide where the line should be drawn. Children who could be expected to respond positively to educational intervention were to be given priority and the ‘hopeless’ excluded.

In October 1940, Asperger started working at the Public Health Office as a specialist physician and, as a member of a committee, he assessed ‘abnormal’ children.

The public health offices in Nazi Germany systematically collected data for a ‘hereditary index’ of the entire population, which was intended to direct racial hygiene measures against those who were considered to have inferior hereditary characteristics.

Neither Spiegelgrund’s files nor those of Asperger’s own department contain any evidence that Asperger ever reported any of his patients to the Public Health Office with a view to sterilisation. These findings support Asperger’s claim of non-participation in the sterilisation programme, although Czech leaves open the possibility that the files were redacted.

Killing system

At the end of 1941, Asperger, together with three of his most murderous colleagues, founded the Vienna Society for Curative Education, which was conceived as a successor to the disbanded German Society for Child Psychiatry and Curative Education. Its co-founders were Max Gundel, Head of the Vienna Public Health Office and Municipal Director of Spiegelgrund, Erwin Jekelius, Medical Director of Spiegelgrund, and Franz Hamburger, Director of the University Paediatric Clinic in Vienna.

If Jekelius was the public face of euthanasia in Vienna, Hamburger was behind the scenes building Vienna’s killing infrastructure. Jekelius was the president of the association, Asperger its second vice-president. Together they worked to synchronise the treatment of children in Vienna and to direct child development efforts under the auspices of the Reich. The Society also had a darker mission, as they used a number of strategies to spread radical Nazi racial hygiene.

While Asperger walked daily past babies being injected, lumbar punctured, infected and starved, Hamburger personally supervised numerous medical experiments on children in the children’s hospital. One medical student exposed children and babies to extreme temperature changes and measured the effects.

An Asperger’s colleague in Hamburger’s postdoctoral fellowship studied the effect of vitamin D on rickets in premature babies; knowing that premature babies were particularly susceptible to the disease, he abandoned prophylaxis and allowed thirteen of the fifteen babies in his control group to get rickets.

Hamburger was personally involved in the deadly experiments on children, having devoted most of his early career to tuberculosis research. He and Elmar Türk, a student of Hamburger’s, did not hide their methods, but promoted their work in publications and medical forums.

Among the many selected for the study was six-month-old Anna Mick, who was in “robust health” despite hydrocephalus and head ulcers. After being put on a prescribed ‘diet’, she lay in a children’s hospital ‘collapsing’, while staff punctured her eyes and body for fluid and tissue samples. In less than four months, she died of “increasing debility”.

As a result of their collaboration with the regime, all of Hamburger’s postdoctoral students after 1945 lost their university teaching permits, but not Asperger. Nine of Hamburger’s eleven students lost their jobs after 1945. Asperger’s decision not to join the Nazi Party exonerated him from this discredit and he was the only Hamburger student to establish himself in the post-war period.

As he worked for the Vienna Public Health Office, he had several points of contact with the Spiegelgrund, which he repeatedly recommended, even though the institution was notorious for its abuse, starvation and violence.

In 1941, two months before her third birthday, Asperger examined a girl named Herta Schreiber at his clinic. Herta showed signs of mental and physical disabilities, having contracted encephalitis a few months earlier. Asperger’s diagnostic report on Herta read: “Severe personality disorder, the most severe motor retardation, idiocy, epileptic seizures. At home, the child must be an unbearable burden for a mother who has five healthy children to care for. A permanent placement in the Spiegelgrund seems absolutely necessary.”

Four days later Hertha was admitted to Am Spiegelgrund, and a month after that Dr Jekelius reported to the Reich Committee for the Scientific Registration of Serious Hereditary and Congenital Diseases, the secret organisation behind the euthanasia of children, that the girl was suffering from “idiocy and does not seek contact with her surroundings”. He ticked the box on the form that Herta’s condition was terminal, which meant that he was in effect asking for permission to kill Herta.

A month later, on 2 September 1941, the day after her third birthday, Herta was executed.

Doctors recorded the cause of death as pneumonia, the most common cause of death in the Spiegelgrund. A note in Herta’s file in the Spiegelgrund shows that her mother knew what fate awaited her child in the institution, but thought it would be better if her daughter died, as others would only laugh at her.

As parents and schools came to Asperger’s for diagnostic evaluations, he had the power to remove children from their families and create their medical records.

Autistic psychopathy had both positive and negative features, so it was possible to draw up a list to determine a child’s worth. Asperger felt that those at the ‘most favourable’ end of his range might be better than ‘normal children’. As adults, they could achieve “outstanding success in highly specialised academic occupations such as mathematicians, technologists, industrial chemists and senior civil servants.”

Asperger’s emphasised qualities that were valuable to the Nazi state, and this may have been a strategic attempt to protect these children from persecution. But he was cruel to children he considered more handicapped and “less favourable cases”, denying their humanity. Since they were incapable of social sense because of their anomalous Gemüt, they could not, in his view, “be an integral part of the world”, for while “a normal child interacts appropriately with others as an integrated member of his community, an autistic psychopath, by his egocentrism, can endanger the community and thus the Volk.”

The Everyday Life of Death

Friedrich Zawrel watched the murders in the Spiegelgrund day after day. The teenager looked through the scratched milk-glass window of his cell in Pavilion 17 at Death Pavilion 15. “I often saw children’s corpses being taken away from the window,” he later recalled.

Strictly speaking, the Spiegelgrund was a social services department, not a medical institution, and one of the Spiegelgrund’s tasks was socialisation.

Parents could voluntarily integrate their children into the social welfare system if they were unable to care for them. Sometimes parents who could have looked after their children but did not want to were also placed in the social welfare system.

The Spiegelgrund, like many other institutions at that time, offered brutal conditions and violent discipline. Interviews with survivors of the Spiegelgrund give some voice to the victims, but the memoirs do not represent the experiences of the children who were victims there.

Survivors said that the daily routine ran like clockwork. After waking up at six in the morning, they had to jump out of bed and stand next to it, then go to the bathroom, where there were bathtubs with only cold water. They were punished for the slightest mistake, and the blows fell day after day. They were dressed in a uniform with shorts and long socks. They had no coats or long trousers, and in rooms without heating they were chilled to the bone.

After the morning wash, a modest breakfast was served, with slices of bread so thin “that you could see all the way to Paris through them”. One of the liquids they regularly received was called Danube, because it was blue. But this was better than later during the war, when worms swam in the rare cabbage soup.

The children were resourceful and looked elsewhere for food. Ferdinand Pauer described how the youngsters would go to the fence and pick vines: “We would twist the leaves, squeeze them and eat them. We also ate lime leaves and gathered walnuts. We ate everything we could.”

Although survivors of the Spiegelgrund spoke of constant hunger, the children were lucky if they managed to keep food in their stomachs. If they vomited, they were forced to eat their own vomit. Leopoldine Maier said that they had to eat their spit-up spoonful by spoonful. “Of course I threw up again and the vomit had to be eaten again, and it was a nightmare.”

Staff were able to give the children a ‘vomit injection’ as punishment. This injection of apomorphine caused stomach pain, vomiting and breathing difficulties for several hours. Johann Gross described its effect as “a strong blow to the stomach, everything was squeezed so that I could hardly breathe. And then immediately the nausea started, I was at the toilet bowl and breakfast was gone. I had to throw up again and again.”

The Spiegelgrund staff also administered “sulphur medicine” to the adolescents, injections of sulphur and related compounds that caused severe pain and paralysis. Johann Gross also received these injections. He said that the sensation was “at first like ice in the thighs, but more and more like a needle prick”. After a few minutes, Gross could no longer sit up and “finally fell to the floor”.

Friedrich Zawrel claimed that he had received the “sulphur cure” eight times and that the muscle pain lasted for up to two weeks.

The daily life of the children in Am Spiegelgrund differed greatly from pavilion to pavilion. Some children were able to attend a kind of school, although the survivors admitted that they learned little. Children may have had limited free time outside on the grounds or in the Spartan recreation room with a handful of games. The compulsory sports could be torturous, as everyone was thin and without strength.

In Pavilion 11, where ‘maladjusted’ children and adolescents were re-educated, they faced daily sadistic punishments. The night-time order in all pavilions was strict. The biggest fear was having to go to the bathroom at night. Leopoldine Maier told of the severe consequences for leaving bed, such as beatings, cold showers and possible withholding of food the next day. But wetting the bed also meant other punishments, such as “kneeling, standing on one leg for hours – if you cried, the punishment was even worse.” The survivors hated that Spiegelgrund pitted the children against each other.

The law of the jungle reigned supreme as the staff dehumanised the children and destroyed all their dignity through constant humiliation. There was no solidarity and they fought for the smallest scraps. Someone whispered to another boy: “If you give me bread, I will do the same to you… in bed.”

Disobedience was also punished by the staff by a method known as the “wrapping treatment.”

Friedrich Zawrel, then 12 years old, recalls: “They wrapped me completely naked in cold wet sheets like a mummy and tied me with belts so I couldn’t move. They put me on the floor so that I could only look at the ceiling. I prayed, but I knew that no one would help me. The sheets were never dry because after two days, when they finally untied you, you were lying in your own urine. It was especially horrible when it made me itch, but I couldn’t scratch, and I endured it until it went away on its own.”

The children who escaped from the Spiegelgrund faced terrible consequences when they were caught. They were tied to a chair and had their hair pulled out until they were naked, then subjected to the “immersion treatment” in icy water until the offender nearly suffocated.

The staff at the Spiegelgrund had more influence in the selection of children for execution than the staff at most other “special children’s wards” in the Reich. They could kill without waiting for official permission from Berlin. Ernst Illing, the second director of the Spiegelgrund, carried out diagnostic procedures on children that could have been life-threatening.

Pneumatic encephalography was a torturous procedure in which, after removing the spinal fluid, air was injected into the children’s brains in order to take X-rays of the brain ventricles. Spiegelgrund’s doctors also collected children’s body parts for research.

The most notorious was Dr Heinrich Gross, who stored the brains of more than four hundred murdered children in jars, carefully stacked and labelled them on shelves in the cellar he used for his research in the 1980s. The body parts of the children murdered in the Spiegelgrund were also sent to a number of research institutions, where they continued to serve as the basis for research long after the war.

Survivors’ accounts of fear and horror included some stories of understanding Spiegelgrund staff who went out of their way to protect the children, but such tales of generosity are rare.

A reckoning

After the war, in 1945, Hans Asperger resumed his academic career and returned to the rebuilt department he had headed during the war, but which had been destroyed by bombing. As he was not a member of the NSDAP, he was absolved of any guilt and was able to continue his work.

He had a long career. In 1957, he was appointed director of the paediatric clinic in Innsbruck. His wife Hanna preferred to stay in Vienna, where Asperger was appreciated especially for his teaching activities.

In 1962, he was appointed head of paediatrics at the Vienna hospital and was its director until his official retirement in 1977, when he became professor emeritus.

Three years later, on 20 October 1980, Hans Asperger died after a short illness.

With the success of his textbook Heilpädagogik, which was published in several editions, his field of curative education was broadened and shifted towards general “special education”.

After the war, Asperger declared his opposition to the Nazi programme of euthanasia of children, which he described as “totally inhuman”. He claimed that he was in danger because he refused to register his children, and that he was twice threatened with arrest for this. Although no record of these incidents has ever been found, Asperger gained a reputation as a rebel against Nazism, even as a victim of the regime.

He may indeed have felt as if he was in a “truly dangerous situation” and was forced to participate in the euthanasia programme, but he had many voluntary ties with the programme’s practitioners that permeated his professional world.

His post-war publications can give some insight into how he may have understood his role in the euthanasia system, and indicate how he eventually came to terms with it. In his words, the disease changed children’s souls and aged them prematurely, thus ending their development. It was fitting that they died earlier than others. By sending them to the Spiegelgrund, Asperger may have believed that he was “serving death”. He was not playing God, but only helping him.

After the fall of the Third Reich, he moved away from his work on autistic psychopathy and did not engage in further systematic research, which raises the question of to what extent he believed in his Nazi-era work at all.

Many believe that Dr Hans Asperger emphasised the special abilities of children and their potential value to the state in technical professions in order to protect them from being killed in the Nazi euthanasia programme. According to this view, Asperger used the diagnosis of autism as a psychiatric Schindler’s List.

The whole history of Asperger, autism and Vienna reveals a tragic trajectory in the science of self-image. Sigmund Freud‘s generation of famous psychoanalysts and psychiatrists gave birth to a generation of children that was among the most controlled, guided and persecuted in history.

The social workers of inter-war Vienna created a welfare system that ultimately destroyed the children in its care. The dark elements of Viennese psychiatry and social welfare came to the fore, so that in the Third Reich, new standards created a system of diagnosis in which the identification of more and more defects required ever more invasive measures.

Nazi psychiatry wiped out the individuality of thousands of children, declared them incorrigible, deprived them of friends and family and isolated them in nightmares that paved the way to their deaths.

Although Asperger’s definitions of autistic psychopathy were variable, his final description in 1944 had a lasting impact. His words live on, shaping the lives and self-image of millions of individuals. As with Asperger and his contemporaries, the concept of autism today is based on concerns about fitting into a perfectionistic and rapidly changing world.