April 2011 - Anesthesia History Association

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BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY
HISTORY
Germany. .. Continued from Page 21
curb the abuse; physicians now prescribed
Pervitin for various vague or trivial indications.
In a March 1940 speech to the Nazi
Medical Association in Berlin, Conti
warned his colleagues that their laxity seriously
threatened the “Volk’s” health. In
early 1941, German newspapers quoted reports
in the British press and from the BBC
attributing the brilliant German military
successes to the use of stimulants and
claiming that German pilots captured in
England carried Pervitin. There were stories
of German soldiers taking Pervitin
before visiting French brothels where the
girls used the “love pill” Maxiton (amphetamine).
In the spring of 1941, the Berlin
police uncovered a large black market of
Pervitin, including deliveries to a popular
brothel.
At Conti’s prompting, Ernst Speer
(1889-1964), a noted psychiatrist and director
of the Lindau Institute of Psychiatry,
reviewed the literature on, and his experience
with, Pervitin. He published his
conclusions in the January 1941 issue of a
prominent medical journal.(13) He had
found no sound medical indications for the
drug, not even in psychiatry, and knew of
numerous cases of true addiction or chronic
abuse. For Speer, the drug’s only indication
was life-threatening exhaustion, as in
military drivers or motorcycle riders. A few
physicians objected to Speer’s conclusions
and felt that he exaggerated the drug’s dangers
and ignored some sound indications.
Conti, however, accepted Speer’s recommendations
and in mid-June 1941 asked the
Interior Minister to place Pervitin under
the “Opium Law” (the German equivalent
of regulations for controlled substances).
The decree, published on July 1, 1941,
threatened severe penalties but exempted
the research institutions, and, implicitly,
the armed forces. Conti’s decision was
clearly detailed by his assistants Kaerber
(14) and Gruenwald (15) who insisted that
the drug should never be prescribed for
healthy subjects and that other, safer drugs
were available for true medical indications.
The abuse of Pervitin by civilians markedly
decreased after 1941 because of the new
law, but also because of competition with
the military and difficulties in production
and distribution caused by the Allied bombings.
However, physicians still occasionally
prescribed it for depression, narcolepsy,
apathy and Parkinson’s syndrome. Towards
the end of the war, large amounts of Pervitin
were distributed to the armament workers
to increase their output during the night
shifts.(2)
Pervitin in the Armed Forces
(Wehrmacht)
1. Army (Heer)(2,3,16-18)
As the Army, especially its motorized
divisions, expanded after 1935, the German
drug companies saw a large potential market
for their stimulants. In October 1938,
Boehringer and Knoll, and in early 1939,
Temmler, recommended their stimulants
Benzedrine and Pervitin respectively, to
General Dr A. Waldman, the Army’s Medical
Inspector (the highest medical officer).
Up to May 1939, Dr Waldman had refused
to introduce stimulants in the service, but
he, however, asked Dr O. Ranke to study
the matter. In May 1937, Ranke had become
chairman of the Department of Physiology
at the Berlin Medico-Military Academy,
the Army’s medical school and research
center. An aggressive scientist interested
in work physiology, Ranke had read
Hauschild’s papers and was in close contact
with his colleagues at the Dortmund
Institute of Work Physiology. In the last
week of September 1938, he started studying
Pervitin’s effects on the physical and
mental activity of sleep-deprived cadets. He
could not complete his experiments as some
of his subjects developed cardiac
arrhythmias or abused the drug to “cram”
for their examinations. He resumed his
experiments in April and May 1939 testing
Pervitin, Benzedrine and caffeine against
a control (dextrose) and adding a psychiatrist
to test the cadets’ mental and motor
skills. Because of side-effects (attributed to
overdose) and again because of abuse by
the “cramming” students, Ranke again did
not finish his study. He, however, reached
some conclusions that he sent to the Medical
Inspector:
1. As stimulants, Pervitin and Benzedrine
were equipotent but superior
to caffeine.
2. Pervitin in 3-6 mg doses maintained
alertness and good mental
and motor skills for up to eight
hours.
3. It could cause physical collapse if
used over 24-36 hours. Its use
should always be followed by a long
restorative sleep.
4. It should always be given under
medical supervision.
5. It would not reverse alcohol intoxication.
From May through August 1939, i.e.,
immediately before the onset of the Polish
campaign (September 1, 1939), Ranke distributed
large amounts of Pervitin to the
medical officers of motorized units to test
it against fatigue. In October 1939 at Dr
Waldman’s request, he interviewed the physicians
who had been in Poland. They had
taken Pervitin themselves or given it to officers
and soldiers exhausted by the long
and rapid advances. All were enthusiastic:
Pervitin had kept them alert, clear-thinking
and proficient and it had saved many
lives by preventing accidents with tired
drivers and motorcycle riders.
Visiting the Western front the same
month, Ranke found that many overworked
junior officers carried Pervitin in
their briefcases, using it frequently and
with excellent results. Ranke reported his
findings to the Inspector while deploring
the lack of good control studies, repeating
his previous guidelines and warning of the
danger of addiction and chronic abuse. In
fact, in November 1939, Ranke wrote to the
Health Leader Conti recommending that
Pervitin become a controlled substance.
In early 1940, Inspector Waldman sent
Dr Krueger, an assistant of Ranke’s at the
Medico-Military Academy, to interview the
medical officers who had served in Poland
to obtain another, unbiased opinion. In his
April 1940 report, Krueger confirmed the
enthusiasm for Pervitin but noted that
some interviewees had misgivings about
its abuse. The same month Ranke recommended
that the Army adopt Pervitin, provided
administration was done by a medical
officer and only in exceptional cases of
life-threatening exhaustion.
Informed of these reports (possibly by
Ranke himself), the firm Temmler then resubmitted
its request for the adoption of
Pervitin into the service. In late April 1940,
General Waldman issued a directive, written
with Ranke’s help, accepting the drug
in the Army, provided it be used as recommended
by Ranke. Tubes of 30 tablets of 3
mg were added to the units’ medical packs.
Waldman’s directive was complemented by
an ordinance of General v. Brauchitsch,
the Army’s Commander in Chief, extolling
Pervitin as a boon for fighting Germany.
Pervitin was thus officially available
during the Western campaign of May-June
1940. From April through December 1940,
the military medical depots dispensed 30
million Pervitin tablets. Ranke was attached
to General v. Kleist’s Army Corps,
which included many motorized divisions,
during its rapid advances across France
of May 1940. Reviewing the use of Pervitin