The untold story of Leo Alexander's investigation into Nazi medical atrocities and the creation of the Nuremberg Code that established modern medical ethics
In the aftermath of World War II, as the world struggled to comprehend the depths of Nazi brutality, a remarkable Jewish psychiatrist and émigré found himself at the center of one of history's most significant trials. Dr. Leo Alexander, an Austrian-born American neuro-psychiatrist, became a pivotal figure in uncovering the medical atrocities committed by Nazi doctors and scientists 1 . His work not only helped bring perpetrators to justice but led to the creation of the Nuremberg Code—the foundational document of modern medical ethics that continues to protect human rights in research to this day.
Ulf Schmidt's "Justice at Nuremberg: Leo Alexander and the Nazi Doctors' Trial" masterfully reconstructs this crucial chapter in medical history through extensive research into Alexander's previously unexplored personal papers, diaries, and correspondence 4 5 . This article explores how Schmidt's work illuminates the origins of modern medical ethics and why the legacy of Nuremberg remains frighteningly relevant in today's world of rapid biomedical advancement.
The Doctors' Trial (1946-1947) was the first of twelve trials of Nazis conducted by American Military Tribunals at Nuremberg. Twenty-three prominent physicians and scientists stood accused of unconscionable acts—torture and murder disguised as medical experiments on concentration camp prisoners 1 . These weren't marginal figures but respected members of Germany's scientific community who had abandoned their ethical obligations in pursuit of scientific advancement and ideological goals.
Schmidt presents Alexander as a complex, driven figure—a "frustrated and traumatized Jew" with a dominant personality, described as "unlikable," "very authoritative," and "conscious of his own importance" 1 . Born in Vienna, Alexander had been forced to immigrate to the United States and abandon his ambition to become a revered physician like his father. Schmidt suggests that Alexander's "longing for revenge became a reality no matter how hard he tried to suppress these feelings after the war" 1 .
Alexander served as a chief medical expert and investigator for the American prosecution, tasked with the "top secret" mission of documenting Nazi medical crimes 2 . His meticulous approach to gathering evidence—recorded in recently discovered diaries and correspondence—provided the foundation for the prosecution's case 4 .
Alexander's investigation revealed how German medicine had been systematically perverted to serve the Nazi regime. He documented how physicians who had taken the Hippocratic Oath to "do no harm" had instead become willing accomplices in torture and murder under the guise of scientific research. Schmidt's research shows how Alexander painstakingly gathered evidence from concentration camps, interviewed survivors, and secured documentary evidence that would be used in court 4 5 .
| Experiment Type | Location | Principal Researcher | Purpose | Victim Impact |
|---|---|---|---|---|
| High-Altitude | Dachau | Sigmund Rasher | Test human limits at altitude | Death, permanent injury |
| Hypothermia | Dachau | Sigmund Rasher | Treatment for cold exposure | Extreme suffering, death |
| Malaria | Dachau | Claus Schilling | Test malaria treatments | Deliberate infection, deaths |
| Sea Water | Dachau | Wilhelm Beiglböck | Make sea water potable | Severe dehydration, organ damage |
| Sulfanilamide | Ravensbrück | Karl Gebhardt | Test wound treatments | Deliberate wounding, infections |
| Sterilization | Multiple | Carl Clauberg | Develop mass sterilization | Permanent infertility |
Evaluate scientific claims and methods
Conduct interviews and review documents in German
Real-time recording of observations and evidence
Perhaps Alexander's most enduring legacy was his role in developing the Nuremberg Code—the first authoritative international guideline for ethical human experimentation 1 . Schmidt reveals that the Code emerged from the trial itself, shaped by many participants including Nazi defense lawyers, rather than being solely the product of any single individual 1 .
The Code established ten foundational principles for ethical research, with informed consent as its cornerstone. This revolutionary concept stated that human subjects must voluntarily agree to participate in research after understanding its purposes, methods, benefits, and risks 1 .
| Principle | Description | Modern Application |
|---|---|---|
| Voluntary Consent | Absolute requirement for informed, voluntary consent | Foundation of all modern research ethics protocols |
| Socially Beneficial | Experiment should yield results for society's good | Research must have scientific merit and social value |
| Prior Knowledge | Based on previous animal studies and natural history | Preclinical data required before human trials |
| Avoid Unnecessary Suffering | No physical or mental suffering should be inflicted | Risk minimization and compassionate care requirements |
| No Death or Disability | No experiment where death/disability is anticipated | Risk-benefit analysis and safety monitoring |
| Risk Proportionality | Degree of risk should not exceed humanitarian importance | Institutional Review Boards assess risk proportionality |
| Proper Preparation | Adequate facilities and protection against injury | Research infrastructure and safety requirements |
| Qualified Researchers | Only scientifically qualified persons should conduct research | Researcher credentials and competency requirements |
| Freedom to Withdraw | Subject can end participation at any time | Right to withdraw without penalty in all consent forms |
| Prepared to Terminate | Researcher must be prepared to stop if risks emerge | Data safety monitoring boards and stopping rules |
"The protection of the lives, dignity and rights of humans is what really matters." 2
Among the most horrific experiments Alexander investigated were the hypothermia studies conducted by Sigmund Rasher at Dachau concentration camp 1 . These experiments exemplified the brutal intersection of scientific curiosity and utter disregard for human life.
Healthy prisoners were chosen as test subjects without voluntary consent
Subjects were immersed in ice water tanks (2-4°C) or exposed naked to sub-zero temperatures outdoors
Body temperature, heart function, and other physiological measures were recorded as hypothermia progressed
Various methods were tested to revive victims, including warm water, animal warmth, and internal irrigation
Alexander's investigation revealed that the experiments caused extreme suffering and high mortality. Victims experienced agonizing pain, convulsions, and permanent physical damage. Those who survived were often left with chronic health problems 1 .
Schmidt documents Alexander's ambivalence toward these experiments. While utterly condemning their ethical violations, Alexander acknowledged that Rasher had "settled the issue of treatment after exposure to cold" 1 . This uncomfortable acknowledgment highlights the ethical dilemma of using data obtained through torture—a debate that continues today regarding research derived from unethical sources.
The hypothermia experiments exemplified the core ethical failure that the Nuremberg Code sought to address: the complete subordination of human dignity to scientific curiosity. The data collected at Dachau represented knowledge gained at the price of unimaginable human suffering—a trade-off that modern ethics unequivocally rejects.
Schmidt argues compellingly that the legacy of Nuremberg is more relevant today than ever before 2 . The ethical challenges posed by emerging technologies—from genetic engineering to artificial intelligence to pharmaceutical testing—continually raise questions about the balance between scientific progress and human rights.
The Nuremberg Code established the foundational principle that the protection of human dignity must always take precedence over scientific curiosity 2 4 . This principle continues to guide:
Schmidt also reveals the uncomfortable truth that many of the Nuremberg Code's architects, including both Alexander and Ivy, "never viewed the Nuremberg Code as applying to their own research work" 1 . After the trial, each reverted to pre-war physician-centered Hippocratic ethics in their own practice. This disconnect between ethical proclamation and personal practice serves as a cautionary tale about the ongoing challenge of maintaining ethical consistency.
Ulf Schmidt's "Justice at Nuremberg" offers far more than historical documentation—it provides a moral compass for navigating the complex ethical terrain of modern medical research. Through the lens of Leo Alexander's complicated journey, we understand that medical ethics is not a destination but a continuous process of vigilance, reflection, and commitment to human dignity.
The Nuremberg Code emerged from one of humanity's darkest chapters, but its principles continue to shine a light on the path toward ethical research. As we stand on the brink of unprecedented biomedical advancements—from gene editing to artificial intelligence to global vaccine development—the lessons of Nuremberg remind us that no scientific breakthrough is valuable enough to justify the sacrifice of human rights and dignity.
As Schmidt concludes, "the protection of the lives, dignity and rights of humans is what really matters" 2 . This profound truth, born from the horrors of Nazi medicine, remains our most vital guidance in balancing scientific progress with our fundamental humanity.