how many people were killed atbernburg, brandenburg, grafeneck, hadamar, hartheim, hadamar, and sonnenstein

During 1940 the centres at Brandenburg, Grafeneck and Hartheim killed nearly 10,000 people each, while another 6,000 were killed at Sonnenstein. In all, about 35,000 people were killed in T4 operations that year. Operations at Brandenburg and Grafeneck were wound up at the end of the year, partly because the areas they served had been cleared and partly because of public opposition. In 1941, however, the centres at Bernburg and Sonnenstein increased their operations, while Hartheim (where Wirth and Franz Stangl were successively commandants) continued as before. As a result, another 35,000 people were killed before August 1941, when the T4 programme was officially shut down by Hitler.

Aktion T4

"Aktion T4Hitler's order for Aktion T4Also known as T4 Program Location German-occupied Europe Date September 1939 – August 1941Incident type Forced euthanasia Perpetrators SSParticipants Psychiatric hospitals Victims 70,273 [1]Aktion T4 (German, pronounced [akˈtsi̯oːn teː fiːɐ]) was the postwar designation for a programme of involuntary euthanasia in Nazi Germany. [2] The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in spring 1940 in the Berlin borough of Tiergarten, which recruited and paid personnel associated with T4. [3] [4] Under the programme certain German physicians were authorized to sign off patients ""deemed incurably sick, after most critical medical examination"" and then administer to them a ""mercy death"" (German: Gnadentod ). [5] In October 1939 Adolf Hitler signed a ""euthanasia decree"" backdated to 1 September 1939 that authorized Reichsleiter Philipp Bouhler, the chief of his Chancellery, [6] and Dr. Karl Brandt, Hitler's personal physician, to carry out the programme of involuntary euthanasia: Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [ menschlichem Ermessen ], are considered incurable, can be granted mercy death [ Gnadentod ]. — Adolf Hitler [7] [8]The programme ran officially from September 1939 [9] to August 1941, [10] during which the recorded 70,273 people were killed at various extermination centres located at psychiatric hospitals in Germany and Austria, [1] along with those in occupied Poland. [11] About half of the victims were from church-run asylums. [12]Several rationales for the programme have been offered, including eugenics, compassion, reducing suffering, racial hygiene, cost effectiveness and pressure on the welfare budget. [13] [14] After the formal end date of the programme, physicians in German and Austrian facilities continued many of the practices that had been instituted under Aktion T4, until the defeat of Germany in 1945. [15] [16] The unofficial continuation of the policy led to additional deaths by medicine and similar means; [17] resulting in 93,521 beds ""emptied"" by the end of 1941. Historians estimate that twice the official number of T4 victims may have perished before the end of the war. [17] [18] [19] In addition, technology that was developed under Aktion T4, particularly the use of lethal gas to commit mass murder, was subsequently taken over by the medical division of the Reich Interior Ministry, along with transfer of personnel who had participated in the development of the technology and later served with Operation Reinhard. [20] This technology, the personnel and the techniques developed were instrumental in the implementation of the Holocaust. [21]Background This poster (from around 1938) reads: ""60,000 Reichsmark is what this person suffering from a hereditary defect costs the People's community during his lifetime. Fellow citizen, that is your money too. Read ' [A] New People ', the monthly magazine of the Bureau for Race Politics of the NSDAP . ""The term ""Aktion T4"" was only introduced after 1945. At the time of the programme implementation the German terminology varied euphemistically between Euthanasie ("" euthanasia "") and Gnadentod (""merciful death""). [7] The T4 programme stemmed from the Nazi Party's policy of "" racial hygiene "", [22] the belief that the German people needed to be ""cleansed"" of so-called racial enemies, which included people with disabilities as well as anyone confined to a mental health facility. [22] The 'euthanasia' programme was a major step in the evolution of policy that culminated in the extermination of the Jews of Europe during the Holocaust. [13] Hitler's ideology had embraced the enforcement of ""racial hygiene"" from its outset. In his book Mein Kampf (1924), Hitler wrote that one day the task: ""will appear as a deed greater than the most victorious wars of our present bourgeois era."" [23]The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary ""antisocial"" behaviour was widely accepted. Canada, Denmark, Switzerland and the US adopted coerced sterilisation legislation before Germany. Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation. [24]The policy and research agenda in racial hygiene and eugenics were actively promoted by Emil Kraepelin. [25] The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugene Bleuler [26] who presumed racial deterioration because of mental and physical cripples in his Textbook of Psychiatry: [27]The more severely burdened should not propagate themselves… If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate. [27]The Nazis began to implement ""racial hygiene"" policies as soon as they came to power. The July 1933 ""Law for the Prevention of Hereditarily Diseased Offspring"" prescribed compulsory sterilisation for people with a range of conditions thought to be hereditary, such as schizophrenia, epilepsy, Huntington's chorea and ""imbecility"". Sterilisation was also mandated for chronic alcoholism and other forms of social deviance. [28] The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts ( Erbgesundheitsgerichte ), which examined the inmates of nursing homes, asylums, prisons, aged-care homes, and special schools to select those to be sterilised. [29]It is estimated that 360,000 people were sterilised under this law between 1933 and 1939. Within the Nazi administration, some suggested that the programme should be extended to people with physical disabilities, but such ideas had to be expressed carefully, given that one of the most powerful figures of the regime, Joseph Goebbels, had a deformed right leg. [30] After 1937 the acute shortage of labour in Germany, arising from the demands of the crash rearmament programme, meant that anyone capable of work was deemed to be ""useful"" and thus exempted from the law. The rate of sterilisation declined. [29]Implementation NSDAP Reichsleiter Philipp Bouhler, Head of the T4 programme Both his physician, Dr. Karl Brandt, and the head of the Reich Chancellery, Hans Lammers, testified after the war that Hitler had told them as early as 1933—at the time when the sterilisation law was passed—that he favoured the killing of the incurably ill, but recognised that public opinion would not accept this. In 1935 Hitler told the Leader of Reich Doctors, Gerhard Wagner, that the question could not be taken up in peacetime: ""Such a problem could be more smoothly and easily carried out in war."" He wrote that he intended to ""radically solve"" the problem of the mental asylums in such an event. [31]Although officially started in September 1939, Aktion T4 was initiated with a ""trial"" case in late 1938. [32] Hitler instructed his personal physician, Karl Brandt, to evaluate a family's petition for the ""mercy killing"" of their blind, physically and developmentally disabled boy. [33] The child, born near Leipzig and identified as Gerhard Kretschmar eventually, [34] was killed in July 1939. [35] Hitler instructed Brandt to proceed in the same manner in all similar cases. [36] Three weeks after the killing of the boy, the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established on 18 August 1939. It was to prepare and proceed with the registration of sick children or newborns identified as defective. Secret killing of infants began in 1939 and increased after the war started. By 1941 more than 5,000 children had been killed. [37]Hitler was in favour of killing those whom he judged to be "" unworthy of life "". In a 1939 conference with health minister Leonardo Conti and the head of the Reich Chancellery, Hans Lammers —a few months before the 'euthanasia' decree—Hitler gave as examples the mentally ill who he said could only be ""bedded on sawdust or sand"" because they ""perpetually dirtied themselves"" and ""put their own excrement into their mouths."" This issue, according to the Nazi regime, assumed new urgency in wartime. [38] After the invasion of Poland the leading Nazi doctor, Dr. Hermann Pfannmüller, said: ""It is unbearable to me that the flower of our youth must lose their lives at the front while that feeble-minded and asocial element can have a secure existence in the asylum"". Pfannmüller advocated gradual decrease of the food rations rather than death by medicine, which he believed was more merciful than poison injections. [39]Dr. Karl Brandt, Hitler 's personal physician and organiser of Aktion T4The German eugenics movement had an extreme wing even before the Nazis came to power. As early as 1920, Alfred Hoche and Karl Binding advocated killing those whose lives were ""unworthy of life"" (lebensunwertes Leben). [40] Darwinism was interpreted by them as justification of the demand for ""beneficial"" genes and eradication of the ""harmful"" ones. Historian Robert Lifton noted: ""The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration"". [41]The advocation of eugenics in Germany gained ground after 1930, when the Depression caused sharp cuts in funding to state mental hospitals, creating squalor and overcrowding. [42] Most German eugenicists were already strongly nationalist and anti-Semitic, and embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes. Their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged. [43]During the 1930s the Nazi Party carried out a campaign of propaganda in favour of ""euthanasia"". The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance ( Das Erbe, 1935), The Victim of the Past ( Opfer der Vergangenheit, 1937), which was given a major première in Berlin and was shown in all German cinemas, and I Accuse ( Ich klage an, 1941), which was based on a novel by consultant for ""child euthanasia"" Hellmuth Unger. [44]Killing of children Main article: Child euthanasia in Nazi Germany Schönbrunn Psychiatric Hospital, 1934. Photo by SS photographer Friedrich Franz Bauer. In mid-1939 Hitler authorized the creation of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses ( Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden ), headed by Dr. Karl Brandt, his personal physician, and administered by Herbert Linden of the Interior Ministry as well as SS - Oberführer Viktor Brack. Brandt and Bouhler were authorized to approve applications to kill children in relevant circumstances, [45] [46] though Bouhler left the details to subordinates such as Brack and SA- Oberführer Werner Blankenburg. [47]Extermination centres were established at six existing psychiatric hospitals: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. [22] [48] They played a crucial role in developments leading to the Holocaust. [22] As a related aspect of the ""medical"" and scientific basis of this programme, the Nazi doctors took thousands of brains from 'euthanasia' victims for research. [49]Viktor Brack, organiser of the T4 Programme From August 1939 the Interior Ministry began registering children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the 'guardian' consent element soon disappeared. Those to be killed were identified as ""all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and Down syndrome (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions"". [50] The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed. [51]The Ministry used various deceptions when dealing with parents or guardians particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to ""Special Sections"" for children, where they would receive improved treatment. [52] The children sent to these centres were kept for ""assessment"" for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as "" pneumonia "". Autopsies were usually performed, and brain samples were taken to be used for ""medical research"". This apparently helped to ease the consciences of many of those involved, since it gave them the feeling that the children had not died in vain, and that the whole programme had a genuine medical purpose. [53]Once war broke out in September 1939, the programme adopted less rigorous standards of assessment and a quicker approval process. It expanded to include older children and adolescents. The conditions covered also expanded and came to include""various borderline or limited impairments in children of different ages, culminating in the killing of those designated as juvenile delinquents. Jewish children could be placed in the net primarily because they were Jewish; and at one of the institutions, a special department was set up for 'minor Jewish-Aryan half-breeds'"". [54]At the same time, increased pressure was placed on parents to agree to their children being sent away. Many parents suspected what was really happening, especially when it became apparent that institutions for children with disabilities were being systematically cleared of their charges, and refused consent. The parents were warned that they could lose custody of all their children, and if that did not suffice, the parents could be threatened with call-up for 'labour duty'. [55] By 1941 more than 5,000 children had been killed. [56] The last child to be killed under Aktion T4 was Richard Jenne on 29 May 1945 in the children's ward of the Kaufbeuren - Irsee state hospital in Bavaria, Germany, more than three weeks after troops from the U. S. had occupied the town. [57] [58]Killing of adults SS-Gruppenführer Leonardo Conti Brandt and Bouhler soon developed plans to expand the programme of euthanasia to adults. In July 1939 they held a meeting attended by Dr. Leonardo Conti, Reich Health Leader and state secretary for health in the Interior Ministry, and Professor Werner Heyde, head of the SS medical department. This meeting agreed to arranging a national register of all institutionalised people with mental illnesses or physical disabilities. Invasion of Poland (1 September 1939)The first adults with disabilities to be killed on a mass scale by the Nazi regime were not Germans, but Poles. They were shot by the SS men of Einsatzkommando 16, Selbstschutz and EK- Einmann under direct command of SS- Sturmbannführer Rudolf Tröger, with overall command by Reinhard Heydrich during the genocidal Operation Tannenberg [59] in which 36,000–42,000 people including Polish children died before the end of 1939 in Pomerania. [60] All hospitals and mental asylums of the Wartheland were emptied. The region was incorporated into Germany and earmarked for resettlement by Volksdeutsche following the German conquest of Poland. Notably, the technology for mass gassing of hospital patients had not been invented yet. [61] In the Danzig (now Gdańsk) area, some 7,000 Polish patients of various institutions were shot, while 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany. [62] The first experiments with the gassing of patients were conducted in October 1939 at Fort VII in Posen (occupied Poznań), where hundreds of prisoners were killed by means of carbon monoxide poisoning in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, Reichsführer-SS Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses. [63]Bunker No. 17 in artillery wall of Fort VII in Poznań, used as improvised gas chamber for early experiments The idea of killing adult mental patients soon spread from occupied Poland to adjoining areas of Germany, probably because Nazi Party and SS officers in these areas were most familiar with what was happening in Poland. These were also the areas where Germans wounded from the Polish campaign were expected to be accommodated, which created a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, sent 1,400 patients from five Pomeranian hospitals to undisclosed locations in occupied Poland where they were shot. Likewise, the Gauleiter of East Prussia, Erich Koch, had 1,600 patients murdered out of sight. In all, more than 8,000 Germans were killed in this initial wave of killings carried out under the command of local officials, although Himmler certainly knew and approved of them. [64]The sole legal basis for the programme was a 1939 letter from Hitler, not a formal 'Führer's decree' which would carry the force of law. Hitler deliberately bypassed Health Minister Conti and his department, who might have raised questions about the legality of the programme. He entrusted it to his personal agents Bouhler and Brandt. [65] The programme was administered by Viktor Brack and his staff from Tiergartenstraße 4 disguised as the ""Charitable Foundation for Cure and Institutional Care"" offices which served as the front. It was supervised by Bouhler and Brandt. [66] [67]The officials in charge included Dr Herbert Linden, who had been heavily involved in the children's programme; Dr Ernst-Robert Grawitz, chief physician of the SS; and August Becker, an SS chemist. They personally selected doctors who were to carry out the operational part of the programme; based on political reliability as long-term Nazis, professional reputation, and known sympathy for radical eugenics. The list included physicians who had proved their worth in the child-killing programme, such as Unger, Heinze, and Hermann Pfannmüller. The new recruits were mostly psychiatrists, notably Professor Carl Schneider of Heidelberg, Professor Max de Crinis of Berlin and Professor Paul Nitsche from the Sonnenstein state institution. Heyde became the operational leader of the programme, succeeded later by Nitsche. [68]Listing of targets from hospital records Hartheim Euthanasia Centre, where over 18,000 people were killed. In early October all hospitals, nursing homes, old-age homes and sanatoria were required to report all patients who had been institutionalised for five years or more, who had been committed as ""criminally insane"", who were of ""non- Aryan race"", or who had been diagnosed with any of a list of specified conditions. These included schizophrenia, epilepsy, Huntington's chorea, advanced syphilis, senile dementia, paralysis, encephalitis and ""terminal neurological conditions generally"". Many doctors and administrators assumed that the purpose of the reports was to identify inmates who were capable of being drafted for ""labour service"". They tended to overstate the degree of incapacity of their patients, to protect them from labour conscription – with fatal consequences. [69] When some institutions refused to co-operate, teams of T4 doctors (or in some cases Nazi medical students) visited them and compiled their own lists, sometimes in a very haphazard and ideologically motivated way. [70] At the same time, during 1940 all Jewish patients were removed from institutions and killed. [71]As with the child inmates, the adult cases were assessed by a panel of experts, working at the Tiergartenstraße offices. The experts were required to make their judgments solely on the basis of the reports, rather than on detailed medical histories, let alone examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (meaning death), a - (meaning life), or occasionally a? meaning that they were unable to decide. Three ""death"" verdicts condemned the person concerned. As with reviews of children, over time these processes became less rigorous, the range of conditions considered ""unsustainable"" grew broader, and zealous Nazis further down the chain of command increasingly made decisions on their own initiative. [70]Gassing The first gassings in Germany proper took place in January 1940 at the Brandenburg Euthanasia Centre. The operation was headed by Viktor Brack, who said: ""the needle belongs in the hand of the doctor."" [72] Bottled pure carbon monoxide gas was used. [73] At trials, Brandt described the process as a ""major advance in medical history"". [74] Once the efficacy of the method was confirmed, it became standardised, and instituted at a number of centres across Germany under the supervision of Widmann, Becker, and Christian Wirth – a Kripo officer who later played a prominent role in the extermination of the Jews as commandant of newly built death camps in occupied Poland. In addition to Brandenburg, the killing centres included Grafeneck Castle in Baden-Württemberg (10,824 dead), Schloss Hartheim near Linz in Austria (over 18,000 dead), Sonnenstein Euthanasia Centre in Saxony (15,000 dead), Bernburg Euthanasia Centre in Saxony-Anhalt and Hadamar Euthanasia Centre in Hesse (14,494 dead). The same facilities were also used to kill mentally sound prisoners transferred from concentration camps in Germany, Austria and occupied parts of Poland. Bishop Jan Maria Michał Kowalski, killed at Hartheim Euthanasia Centre. Condemned patients were 'transferred' from their institutions to newly built centres in the T4 Charitable Ambulance buses, called the Community Patients Transports Service. They were run by teams of SS men wearing white coats, to give it an air of medical care. [75] To prevent the families and doctors of the patients from tracing them, the patients were often first sent to transit centres in major hospitals, where they were supposedly assessed. They were moved again to ""special treatment"" ( Sonderbehandlung) centres. Families were sent letters explaining that owing to wartime regulations, it was not possible for them to visit relatives in these centres. Most of these patients were killed within 24 hours of arriving at the centres, and their bodies cremated. [73] For every person killed, a death certificate was prepared, giving a false but plausible cause of death. This was sent to the family along with an urn of ashes (random ashes, since the victims were cremated en masse ). The preparation of thousands of falsified death certificates took up most of the working day of the doctors who operated the centres. [76]

Even after that date, however, the centres continued to be used to kill concentration camp inmates: eventually some 20,000 people in this category were killed. [77]In 1971 the Austrian-born journalist Gitta Sereny conducted a series of interviews with Franz Stangl, who was in prison in Düsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibor and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 programme based on his time as commandant of the killing facility at the Hartheim institute. [78] He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane, and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (this ruse was later used on a much larger scale at the extermination camps). [78]Technology and personnel transfer to death camps See also: Category: Action T4 personnel and T4-Gutachter After the official end of the euthanasia programme in 1941, most of the personnel and high-ranking officials, as well as gassing technology and the techniques used to deceive victims, were transferred under the jurisdiction of the national medical division of the Reich Interior Ministry. [16] Further gassing experiments with the use of mobile gas-chambers ( Einsatzwagen) were conducted at Soldau concentration camp by Herbert Lange following Operation Barbarossa. Lange was appointed commander of the Chełmno extermination camp in December 1941. He was given three gas vans by the RSHA, converted by the Gaubschat Gmb H in Berlin, [79] and already before February 1942 killed a total of 3,830 Polish Jews and around 4,000 Gypsies under the guise of ""resettlement"". [80] After the Wannsee conference, the knowledge acquired in the process was then put to use by Reinhard Heydrich in the deadliest phase of the Holocaust. Beginning in spring 1942 three industrial killing centres were built secretly in east-central Poland. The SS officers responsible for the Aktion T4, including Christian Wirth, Franz Stangl, and Irmfried Eberl, were all given key roles in the implementation of the ""Final Solution"" for the next two years. [21] The first killing centre equipped with stationary gas chambers modelled on Aktion T4 was established at Bełżec in the General Government territory of occupied Poland. Notably, the decision preceded the Wannsee Conference of January 1942 by three months. [81]The official number of victims Victims of Aktion T4 (official data), 1940 – September 1941T4 Center operation number of victimsfrom to 1940 1941 total Grafeneck 20 January 1940 December 1940 9,839 --- 9,839Brandenburg 8 February 1940 October 1940 9,772 --- 9,772Bernburg 21 November 1940 30 July 1943 --- 8,601 8,601Hartheim 6 May 1940 December 1944 9,670 8,599 18,269Sonnenstein June 1940 September 1942 5,943 7,777 13,720Hadamar January 1941 31 July 1942 --- 10,072 10,072total by year: 35,224 35,049 70,273Source: Document 87, P. 232 cit. in Ernst Klee. Dokumente zur ""Euthanasie"", 1985. Voices of opposition Gas chamber in Hadamar In January 1939 Viktor Brack commissioned a paper from Professor of Moral Theology at the University of Paderborn, Joseph Mayer, on the likely reactions of the churches in the event of a state euthanasia programme being instituted. Mayer – a longstanding euthanasia advocate – reported that the churches would not oppose such a programme if it was seen to be in the national interest. Brack showed this paper to Hitler in July, and it may have increased his confidence that the ""euthanasia"" programme would be acceptable to German public opinion. [46] Notably, when Gitta Sereny interviewed Mayer shortly before his death in 1967, he denied that he formally condoned the killing of people with disabilities, but no copies of this paper are known to survive. [82]There were those who opposed the T4 programme within the bureaucracy. Lothar Kreyssig, a district judge and member of the Confessing Church, wrote to Gürtner protesting that the action was illegal since no law or formal decree from Hitler had authorised it. Gürtner replied, ""If you cannot recognise the will of the Führer as a source of law, then you cannot remain a judge"", and had Kreyssig dismissed. [42] Hitler had a fixed policy of not issuing written instructions for policies relating to what could later be condemned by international community, but made an exception when he provided Bouhler and Brack with written authority for the T4 programme in his confidential letter of October 1939 in order to overcome opposition within the German state bureaucracy. Hitler told Bouhler at the outset that ""the Führer's Chancellery must under no circumstances be seen to be active in this matter."" [66] The Justice Minister, Franz Gürtner, had to be shown Hitler's letter in August 1940 to gain his cooperation. [67]Growing awareness In the towns where the killing centres were located, many people saw the inmates arrive in buses, saw the smoke from the crematoria chimneys and noticed that the buses were returning empty. In Hadamar, ashes containing human hair rained down on the town. The T4 programme was no secret. Despite the strictest orders, some of the staff at the killing centres talked about what was going on. In some cases families could tell that the causes of death in certificates were false, e.g. when a patient was claimed to have died of appendicitis, even though his appendix had been surgically removed some years earlier. In other cases, several families in the same town would receive death certificates on the same day. [83] In May 1941 the Frankfurt County Court wrote to Gürtner describing scenes in Hadamar where children shouted in the streets that people were being taken away in buses to be gassed. [84]Hans Gerhard Creutzfeldt in 1920During 1940 rumours of what was taking place spread, and many Germans withdrew their relatives from asylums and sanatoria to care for them at home – often with great expense and difficulty. In some places doctors and psychiatrists co-operated with families to have patients discharged, or, if the families could afford it, had them transferred to private clinics where the reach of T4 did not extend. Other doctors agreed to ""re-diagnose"" some patients so that they no longer met the T4 criteria. This risked exposure when the Nazi zealots from Berlin conducted inspections. In Kiel, Professor Hans Gerhard Creutzfeldt managed to save nearly all of his patients. [85] However, for the most part doctors co-operated with the programme, either from ignorance of its true meaning, agreement with Nazi eugenicist policies, or fear of the regime. [86]During 1940 protest letters were sent to the Reich Chancellery and the Ministry of Justice, some of them from Nazi Party members. The first open protest against the removal of people from asylums took place at Absberg in Franconia in February 1941, and others followed. The SD report on the incident at Absberg noted that ""the removal of residents from the Ottilien Home has caused a great deal of unpleasantness"", and described large crowds of Catholic townspeople, among them Party members, protesting against the action. [87]Others who privately protested were the Lutheran theologian Friedrich von Bodelschwingh, director of the Bethel Institutionfor epileptics at Bielefeld and Pastor Paul-Gerhard Braune, director of the Hoffnungstal Institution near Berlin. Both used their connections with the regime to negotiate exemptions for their institutions: Bodelschwingh negotiated directly with Brandt and indirectly with Hermann Göring, whose cousin was a prominent psychiatrist. Braune had meetings with Justice Minister Gürtner, who was always dubious about the legality of the programme. Gürtner later wrote a strongly worded letter to Hitler protesting against it; Hitler did not read it, but was told about it by Lammers. [88] In general, the leaders of the Protestant church were more enmeshed with the Nazi regime than was the case for Catholics and they were unwilling to criticise its actions. [89]Church protests For more details on this topic, see Nazi euthanasia and the Catholic Church. During 1940 and 1941 some Protestant churchmen protested against T4. Bishop Theophil Wurm, presiding the Evangelical-Lutheran Church in Württemberg, wrote a strong letter to Interior Minister Frick in March 1940. In March 1940 a confidential report from the SD in Austria warned that the killing programme must be implemented with stealth ""in order to avoid a probable backlash of public opinion during the war"". [90] On 4 December 1940 Reinhold Sautter, Supreme Church Councillor of Württemberg's State Church, reproached the Nazi Ministerial Councillor Eugen Stähle for the murders in Grafeneck Castle. Stahle retorted with the Nazi government opinion, that ""The fifth commandment: Thou shalt not kill, is no commandment of God but a Jewish invention"" and no longer had any validity. [91]Bishop Heinrich Wienken of Berlin, a leading member of the Caritas Association, was selected by the Fulda episcopal synod to represent the views of the Catholic Church in meetings with T4 operatives. According to historian Michael Burleigh, ""Wienken seems to have gone partially native in the sense that he gradually abandoned an absolute stance based on the Fifth Commandment in favour of winning limited concessions"". [92]August von Galen Catholic churchmen, led by Cardinal Michael von Faulhaber of Munich, wrote privately to the government protesting against the policy. Theologian Bernhard Lichtenberg protested to the Nazis chief medical officer. [93] In July and August 1941, the Bishop of Münster, August von Galen, gave three sermons criticizing the Nazi state: for arresting Jesuits, confiscating church property, and for the euthanasia program. [94] Von Galen telegrammed the text of his sermon to Hitler, calling on""the Führer to defend the people against the Gestapo"". ""It is a terrible, unjust and catastrophic thing when man opposes his will to the will of God"", Galen said. ""We are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live?"" [95]The Nazi leadership was angered by the sermon's wide circulation - it was even dropped by British Royal Air Force pilots over German troops. [12] [96] Robert Lifton, writing in 1986, stated: ""Nazi leaders faced the prospect of either having to imprison prominent, highly admired clergymen and other protesters – a course with consequences in terms of adverse public reaction they greatly feared – or else end the programme."" [97] Later historians have deprecated the importance of the role of the Church. Burleigh dismissed assumptions that the sermon had any direct effect on Hitler's decision to suspend the T4 program as ""wishful thinking"", and noted in addition that the Churches' hierarchies did not complain after the transfer of T4 personnel to Operation Reinhard. [98] Henry Friedlander stated that it was not the criticism from the Church, but rather the loss of secrecy and ""general popular disquiet about the way euthanasia was implemented"" that caused the suspension of the program. [99]Von Galen had detailed knowledge of the euthanasia program in July 1940, but did not speak out until almost a year after Protestants had begun their protests. [94] Historian Beth A. Griech-Polelle explained the prolonged inactivity of von Galen and the Catholic hierarchy: ""Worried lest they be classified as outsiders or internal enemies, they waited for Protestants, that is the 'true Germans,' to risk a confrontation with the government first. If the Protestants were able to be critical of a Nazi policy, then Catholics could function as 'good' Germans and yet be critical too."" [100]Another Bishop, Franz Bornewasser of Trier, also sent protests to Hitler, though not publicly. In August Galen was even more outspoken, broadening his attack to include the Nazi persecution of religious orders and the closing of Catholic institutions. He attributed the heavy Allied bombing of Westphalian towns to the wrath of God against Germany for breaking His laws. Galen's sermons were not reported in the German press but were widely circulated in the form of illegally printed leaflets. [101] Local Nazis asked for Galen to be arrested but Goebbels told Hitler that such action would provoke open revolt in Westphalia. [102] Hitler decided to wait for revenge on von Galen until after the war. [12]A plaque set in the pavement at No 4 Tiergartenstraße commemorates the victims of the Nazi euthanasia programme. Cancellation of T4 programme On 24 August 1941 Hitler ordered the cancellation of the T4 programme. The invasion of the Soviet Union in June provided new opportunities to use the T4 personnel. Many were transferred to the east to begin work on a vastly greater programme of killing: the "" final solution of the Jewish question"". The projected death total for the T4 program of 70,000, which was set before the program began, had been reached by August 1941. [98] The winding-up of the T4 programme did not end the killing of people with disabilities. From the end of 1941, the killing became less systematic. The killing of adults and children continued to the end of the war, on the local initiative of institute directors and party leaders. The methods reverted to those employed before use of the gas chambers: lethal injection or starvation. [103] By the end of 1941 some 75,000 to 100,000 people had been killed in the T4 programme. The Hartheim and Hardamar centres continued to kill people sent to them from all over Germany until 1945. [18]Post-war history Main article: Euthanasia trials After the war a series of trials was held in connection with the Nazi euthanasia programme at various places including: Dresden, Frankfurt, Graz, Nuremberg and Tübingen. Doctors' trial Main article: Doctors' trial In December 1946 an American military tribunal (commonly called the Doctors' trial) prosecuted 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed ""unworthy of life"", including the mentally disabled, the institutionalized mentally ill, and the physically impaired. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948. They included Dr. Karl Brandt and Viktor Brack. Commemorative plaque on wall on bunker No. 17 in Fort VIIThe indictment read in part:14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, willfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called ""euthanasia"" program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference. [104]Earlier, in 1945, American forces tried seven staff members of the Hadamar killing centre for the killing of Soviet and Polish nationals, which was within their jurisdiction under international law, as these were the citizens of wartime allies. (Hadamar was within the American Zone of Occupation in Germany. This was before the December 1945 Allied resolution supporting prosecution of ""crimes against humanity"" for such mass atrocities.) Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed; the other four were given long prison sentences. [105] In 1946, newly reconstructed German courts tried members of the Hadamar staff for the murders of nearly 15,000 German citizens at the facility. Adolf Wahlmann and Irmgard Huber, the chief physician and the head nurse, were convicted. Others involved Aktion T4 marker (2009) in Berlin See also: Category: Action T4 personnel and T4-Gutachter August Becker, initially sentenced to three years after the war, in 1960 was tried again and sentenced to 10 years in prison. He was released early due to ill-health and died in 1967. Werner Blankenburg lived under an alias and died in 1957. Philipp Bouhler committed suicide in captivity, May 1945. Werner Catel was cleared by a de-nazification board after World War II and was head of pediatrics at the University of Kiel. He retired early after his role in the T4 program came to light. Leonardo Conti hanged himself in captivity, 6 October 1945. Dr. Ernst-Robert Grawitz killed himself shortly before the fall of Berlin in April 1945. Dr. Herbert Linden committed suicide in 1945. Overseers of the program were initially Herbert Linden and Werner Heyde. Linden was later replaced by Hermann Paul Nitsche. Dr. Fritz Cropp d. 6 April 1984, Bremen. A Nazi official, in 1933, in Oldenburg, Cropp was appointed the country medical officer of health. Two years later, in 1935, he transferred to Berlin, where he worked as a ministerial adviser in the Division IV (health care and people care) in the Ministry of the Interior. In 1939, he became Assistant Director. Fritz Cropp was involved in the Nazi ""euthanasia"", the so-called action T-4, in 1940. He was Herbert Linden's superior. He was responsible for patient transfers. [106]Dr. Werner Heyde, after having escaped detection for 18 years, killed himself in 1964 before being brought to trial. Dr. Heinrich Gross was tried twice. One sentence was overturned and another was suspended; he died in 2005. Lorenz Hackenholt vanished in 1945. [107]Erich Koch served time in prison from 1950 to his death in 1986. Erwin Lambert died in 1976. [107]Dr. Friedrich Mennecke died in 1947 while awaiting trial. Philipp, Landgrave of Hesse, the governor of Hesse-Nassau, was not tried for his part in the T4 programme; he died in 1980. Paul Nitsche was tried and executed by an East German court in 1948. Professor Carl Schneider hanged himself in his prison cell in 1946, while awaiting trial. Franz Schwede was sentenced to 10 years in prison in 1948 and was pardoned in 1956; he died in 1960. Dr. Ernst Illing was the director of the Vienna Psychiatric-Neurological Clinic for Children Am Spielgrund, where he killed about 200 children, sentenced to death on 18 July 1946 [108]Dr. Marianne Türk was a doctor at Vienna Psychiatric-Neurological Clinic for Children Am Spielgrund where, together with Ernst Illing, she killed 200 children. She was sentenced to 10 years prison on 18 July 1946. [108]Aktion T4 memorial at Tiergartenstraße 4, Berlin The Ministry for State Security of East Germany stored around 30,000 files of the T4 project in their archives. Those files became available to the public only after the German Reunification in 1990, leading to a new wave of research on these wartime crimes. [109]Memorials The German national memorial to the people with disabilities murdered by the Nazis was dedicated in 2014 in Berlin. [110] [111] It is located in the pavement of a site next to the Tiergarten park, the location of the former villa at Tiergartenstrasse 4 in Berlin, where more than 60 Nazi bureaucrats and doctors worked in secret under the ""T4"" program to organize the mass murder of sanatorium and psychiatric hospital patients deemed unworthy to live. [111]See also Nazi doctors (list)Nazi eugenics, the racially based social policies that placed the improvement of the Aryan race at the heart of Nazis ideology. Nazi medical experimentation Operation Reinhard, men of Aktion T4 provided expertise for building the extermination camps during the Holocaust. Aktion 14f13 (1941–44), a Nazi extermination operation that killed prisoners who were sick, elderly, or deemed no longer fit for work Racial hygiene T4-Gutachter experts selecting victims killed by gas in ""euthanasia"" centers Killing centers Am Spiegelgrund clinic Bernburg Euthanasia Centre Brandenburg Euthanasia Centre Grafeneck Euthanasia Centre Hadamar Euthanasia Centre Hartheim Euthanasia Centre Soldau concentration camp Sonnenstein Euthanasia Centre Jewish skeleton collection Nazi euthanasia and the Catholic Church Notes1 2 Proctor 1988, p. 191.↑ Sandner (1999): 385 (66 in PDF) Note 2. The author claims the term Aktion T4 was not used by the Nazis but was first used in the trials against the doctors and later included in the historiography. (German)↑ Artur Hojan & Cameron Munro (2015). ""Overview of Nazi 'euthanasia' program"". The central office at Tiergartenstrasse 4 in Berlin. The Tiergartenstrasse 4 Association. Retrieved 28 August 2015 – via Nazi Ideology and Ethics By Wolfgang Bialas & Lothar Fritze, pp. 263, 281; ISBN 1443858811.↑ Sereny 1983, p. 48. Tiergartenstraße 4 was the location of the Central Office and administrative headquarters of the Gemeinnützige Stiftung für Heil- und Anstaltspflege (literally, ""Charitable Foundation for Curative and Institutional Care"").↑ Proctor (1988): 177↑ This was the Kanzlei des Führer der NSDAP, not to be confused with the Reich Chancellery or Reichskanzlei.1 2 Miller (2007), 160.↑ Lifton 1986, pp. 63-64. The ""euthanasia decree"" in translation.↑ Peter Longerich, Holocaust: The Nazi Persecution and Murder of the Jews, p. 477 – note 44↑ Browning (2005): p. 193↑ Webb, Chris (2009). ""Otwock & the Zofiowka Sanatorium: A Refuge from Hell"". Holocaust Research Project. Holocaust Education & Archive Research Team. Archived from the original on 11 July 2011 – via Internet Archive.1 2 3 Burleigh 2008, p. 2621 2 Burleigh, Michael; Wolfang Wippermann (2014). ""Nazi Racial Science"". United States Holocaust Memorial Museum United States Holocaust Memorial Museum.↑ Mark B. Adams Associate Professor of the History and Sociology of Science University of Pennsylvania (1990). The Wellborn Science: Eugenics in Germany, France, Brazil, and Russia. Oxford University Press. pp. 40, 84, 191.↑ Ryan & Schuchman 2002, p. 25. The Nuremberg Military Tribunal evidence. Note 34.1 2 Lifton (1986): p. 95 - 961 2 Lifton (1986): p. 142.1 2 Michael Burleigh (1994), Death and Deliverance: 'Euthanasia' in Germany, C.1900 to 1945 CUP Archive, ISBN 0521477697.↑ Ryan & Schuchman 2002, p. 62. Estimated range between 200,000 and 250,000 unofficial victims of policy upon the arrival of Allied troops in Germany.↑ Robert Jay Lifton (2000). The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic Books. p. 102. ISBN 0465049052. Retrieved 2 June 2015.1 2 Sereny 1983, p. 54. Role of T4 ""Inspector"" Christian Wirth in the Holocaust.1 2 3 4 Breggin, Peter (1993). ""Psychiatry's role in the holocaust"" (PDF file, direct download from the Internet Archive, 4.07 MB). International Journal of Risk & Safety in Medicine. 4 (2): 133–148. doi: 10.3233/JRS-1993-4204. PMID 23511221.↑ Hitler, Mein Kampf, 447 (cited by Peter Padfield, Himmler, Macmillan 1990, 260)↑ Hansen and King, 141↑ Engstrom EJ, Weber MM, Burgmair W (October 2006). ""Emil Wilhelm Magnus Georg Kraepelin (1856–1926)"". The American Journal of Psychiatry. 163 (10): 1710. doi: 10.1176/appi.ajp.163.10.1710. PMID 17012678.↑ Joseph, Jay (2004). The Gene Illusion: Genetic Research in Psychiatry and Psychology Under the Microscope. Algora Publishing. p. 160. ISBN 0875863442.1 2 Bleuler E. (1924). Textbook of Psychiatry. New York: Macmillan. p. 214. See: Read J, Masson J (2004). ""Genetics, eugenics and mass murder"". In Read J, Mosher RL, Bentall RP. Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. Hove, East Sussex: Brunner-Routledge. p. 36. ISBN 1583919058.↑ Evans, 5071 2 Evans (2005): 508↑ This was the result either of club foot or osteomyelitis. Goebbels is commonly said to have had club foot ( talipes equinovarus ), a congenital condition. William L. Shirer, who worked in Berlin as a journalist in the 1930s and was acquainted with Goebbels, wrote in The Rise and Fall of the Third Reich (1960) that the deformity was from a childhood attack of osteomyelitis and a failed operation to correct it.↑ Kershaw, II, 256↑ Friedman (2011), p. 146 note 12↑ Lifton thinks this request was ""encouraged""; the severely disabled child and the agreement of the parents to his killing were apparently genuine (Lifton (1986): 50)↑ Schmidt (2007): 118↑ Stephen J. Cina, Joshua A. Perper, When Doctors Kill, p. 59↑ Lifton (1986): pp. 50–51↑ Proctor (1988): p. 10; Browning, 190.↑ Lifton 1986, p. 62.↑ Lifton (1986): pp. 62, 63; quoted in Gerhard Schmidt, Selektion in der Heilanstalt 1939–1945 (Stuttgart: Evangelisches Verlagsanstalt, 1965), p. see pp. 34-35. Hermann Pfannmüller, original text in German: Für mich ist die Vorstellung untragbar, dass beste, blühende Jugend an der Front ihr Leben lassen muss, damit verblichene Asoziale und unverantwortliche Antisoziale ein gesichertes Dasein haben. – From: Gerhard Baader, Psychiatrie im Nationalsozialismus p. 18/27 in PDF, note 66.↑ Their ideas were published in The Permission to Destroy Life Unworthy of Life ( Die Freigabe der Vernichtung lebensunwerten Lebens ), 1920↑ Lifton 1986, p. 47.1 2 Kershaw, II, 254↑ The ready acceptance of Nazi ideas by the majority of the German medical profession is described in Evans, 444↑ Lifton 1986, pp. 48-49.↑ Browning (2005): 1851 2 Kershaw, II, 259↑ Miller (2007), 158↑ Fuller Torrey, Edwin; Yolken, Robert (January 2010). ""Psychiatric genocide: Nazi attempts to eradicate schizophrenia"". Schizophrenia Bulletin. 36 (1): 26–32. doi: 10.1093/schbul/sbp097. PMC 2800142. PMID 19759092.↑ Weindling, Paul Julian (2006). Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent. Palgrave Macmillan. p. 6. ISBN 0-230-50700-X.↑ Lifton 1986, p. 52.↑ These were Professor Werner Catel (a Leipzig psychiatrist); Professor Hans Heinze, head of a state institution for children with intellectual disabilities at Görden near Brandenburg; Ernst Wentzler a Berlin pediatric psychiatrist; and the author Dr. Helmut Unger. (Lifton (1986): 52)↑ Sereny 1983, p. 55.↑ Lifton 1986, p. 60.↑ Lifton 1986, p. 56.↑ Lifton 1986, p. 55.↑ Browning, 190. Lifton concurs with this figure, but notes that the killing of children continued even after the T4 programme was formally ended in 1941.↑ Henry Friedlander (1995). The Origins of Nazi Genocide: From Euthanasia to the Final Solution University of North Carolina Press, 1995. p. 163.↑ Suzanne E. Evans. Forgotten crimes: the Holocaust and people with disabilities. p. 93. Retrieved 25 July 2011.↑ Semków 2006, pp. 46–48. The second phase of Operation Tannenberg referred to as the Unternehmen Tannenberg by Heydrich's Sonderreferat began in late 1939 under the codename Intelligenzaktion and lasted until January 1940.↑ Piotr Semków; IPN Gdańsk (September 2006). ""Kolebka (Cradle)"" (PDF). IPN Bulletin No. 8–9 (67–68), 152 pages. Warsaw: Institute of National Remembrance. 42–50 (44–51/152 in PDF). ISSN 1641-9561. Retrieved 8 November 2015 – via direct download: 3.44 MB.↑ Friedlander (1995): p. 87.↑ Browning, 186–187.↑ Browning, 188↑ Browning, 190, Kershaw, II, 261↑ Lifton 1986, pp. 63, 64. Several drafts of a formal euthanasia law were prepared, but Hitler refused to authorise them. Thus, the senior participants in the programme always knew that it was not a law even by the loose definition of legality prevailing in Nazi Germany.1 2 Padfield, 2611 2 Kershaw, II, 253↑ Lifton 1986, p. 64.↑ Lifton 1986, p. 66.1 2 Lifton, 67↑ Browning, 191, Padfield, 261, 303, Lifton (1986): 77. According to Lifton, most Jewish inmates of German mental institutions were dispatched to Lublin in Poland in 1940 and killed there.↑ George J. Annas, and Michael A. Grodin (1992). The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation. Oxford University Press. p. 25. ISBN 0199772266 – via Google Books, preview.1 2 Lifton, 71↑ Lifton 1986, p. 72.↑ Burleigh, Michael (2000): p.54↑ Lifton 1986, p. 74.↑ These figures come from the article Aktion T4 on the German Wikipedia, which sources them to Ernst Klee, ""Euthanasie"" im SS-stadt: Die ""Vernichtung lebensunwerten Leben"" (""Euthanasia"" in the SS-state: The extermination of ""life unworthy of life""), Frankfurt, 19831 2 Sereny 1983, pp. 41–90.↑ Mathias Beer (translated from the German) (2015). ""The Development of the Gas-Van in the Murdering of the Jews"". The Final Solution. Jewish Virtual Library. ""Die Entwicklung der Gaswagen beim Mord an den Juden,"" Miszelle. Vierteljahrshefte fuer Zeitgeschichte, 37 (3), pp. 403-417. Retrieved 27 June 2015.↑ WUW (2013). Ringelblum Archives of the Holocaust. Introduction (PDF file, direct download). Wydawnictwa Uniwersytetu Warszawskiego. p. 20 (xx). Retrieved 13 May 2013.↑ Historia Niemieckiego Obozu Zagłady w Bełżcu (History of the Belzec extermination camp) (in Polish), Muzeum - Miejsce Pamięci w Bełżcu (National Bełżec Museum & Monument of Martyrology), retrieved 24 May 2015↑ Sereny 1983, p. 71.↑ Lifton 1986, p. 75.↑ Sereny 1983, p. 58.↑ Lifton 1986, p. 82. Creutzfeldt is also remembered as the co-discoverer of Creutzfeldt–Jakob disease↑ Lifton 1986, p. 80. Lifton lists a handful of psychiatrists and administrators who actively opposed the T4 programme.↑ Lifton 1986, p. 90.↑ Lifton 1986, pp. 90-92.↑ Sereny 1983, pp. 69, 74.↑ Padfield, 304↑ Schmuhl (1987): p. 321.↑ Burleigh 2008, p. 261↑ Ten Catholic Heroes-of-the Holocaust Catholic Herald.co.uk.1 2 Robert P. Ericksen. (2012). Complicity in the Holocaust. [Online]. Cambridge: Cambridge University Press. Available from: Cambridge Books Online doi: 10.1017/CBO9781139059602 [Accessed 20 April 2016]. page 111↑ Lifton 1986, p. 93.↑ Lifton 1986, p. 94↑ Lifton 1986, p. 951 2 Burleigh 2008, p. 263↑ Henry Friedlander (1 September 1997). The Origins of Nazi Genocide: From Euthanasia to the Final Solution. Univ of North Carolina Press. p. 111. ISBN 978-0-8078-4675-9.↑ Beth A. Griech-Polelle (1 October 2008). Bishop von Galen: German Catholicism and National Socialism. Yale University Press. p. 76. ISBN 978-0-300-13197-0.↑ Kershaw, II, 427↑ Kershaw, II, 429↑ Lifton 1986, pp. 96-102.↑ ""Transcription"". United States Holocaust Museum. Archived from the original on 4 May 2006.↑ ""Captured German Records"" (PDF). National Archives and Records Administration.↑ Ernst Klee: Fritz Cropp, Eintrag in ders. : Das Personenlexikon zum Dritten Reich. Wer war was vor und nach 1945. Aktualisierte Ausgabe. Fischer-Taschenbuch-Verlag, Frankfurt am Main 2005, ISBN 3-596-16048-0, S. 981 2 Berenbaum: p. 2471 2 Totten & Parsons (2009): 181 ss.↑ Horst von Buttlar: Forscher öffnen Inventar des Schreckens at Spiegel Online (1 October 2003) (German)↑ ABC News. ""International News - World News - ABC News"". ABC News.1 2 ""Berlin Dedicates Holocaust Memorial for Disabled - Global Agenda - News - Arutz Sheva"". Arutz Sheva. References Bachrach, Susan D; Kuntz, Dieter; United States Holocaust Memorial Museum (2004). Deadly Medicine: Creating the Master Race. Washington D. C.: United States Holocaust Memorial Museum: Chapel Hill, NC: Distributed by the University of North Carolina Press. ISBN 0-8078-2916-1. Benzenhöfer, Udo (2010). Euthanasia in Germany Before and During the Third Reich. Münster/Ulm: Verlag Klemm & Oelschläger. ISBN 978-3-86281-001-7 – via Google Books, no preview. Berenbaum, Michael; Peck, Abraham J. 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New York: Mac Millan and Company. ISBN 978-0-02-625970-5. Thompson, D. (2004). ""Axis History Forum. The Nazi Euthanasia Program"". Totten, Samuel; Parsons, William S. (2009). Century of genocide: critical essays and eyewitness accounts (Third ed.). New York: Routledge. ISBN 978-0-415-99084-4. BBC (1997), The Nazis: A Warning from History (internal link), television documentary Joanna Mack (dir. ), Channel 4 (22 October 1991), Selling Murder: The Killing Films of the Third Reich, Domino Films / Channel 4 (UK television), tx. includes excerpts from Opfer der Vergangenheit and Ich klage an Astrid Ley, Annette Hinz-Wessels (editors), The ""Euthanasia Institution"" of Brandenburg an der Havel. – Murder of the ill and handicapped during National Socialism, ISBN 978-3-86331-086-8Ian Kershaw (2000), Hitler: 1936-1945 Nemesis, volume II, Norton, ISBN 978-0393322521External links Wikimedia Commons has media related to Action T4. 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Lithuanian Security Police Trawniki Ypatingasis būrys Pieter Menten Resistance: Judenrat, victims, documentation and technical Organizations AK AOB Bund GL PKB ŻOB ŻZAUprisings Ghetto uprisings Białystok Częstochowa Sobibór Treblinka Warsaw Ghetto Uprising Leaders Mordechai Anielewicz Dawid Moryc Apfelbaum Icchak Cukierman Marek Edelman Leon Feldhendler Paweł Frenkiel Henryk Iwański Itzhak Katzenelson Michał Klepfisz Miles Lerman Alexander Pechersky Witold Pilecki Frumka Płotnicka Roza Robota Szmul Zygielbojm Judenrat Jewish Ghetto Police Adam Czerniaków Mordechai Chaim Rumkowski Victim lists Ghettos Kraków Łódź Lvov (Lwów) Warsaw Camps Auschwitz Bełżec Gross-Rosen Izbica Majdanek Sobibór Soldau Stutthof Trawniki Treblinka Documentation Nazi sources Auschwitz Album Frank Memorandum Höcker Album Höfle Telegram Katzmann Report Korherr Report Nisko Plan Posen speeches Special Prosecution Book-Poland Stroop Report Wannsee Conference Witness accounts Graebe affidavit Gerstein Report Vrba-Wetzler report Witold's report Sonderkommando photographs Concealment Sonderaktion 1005Technical and logistics Identification in camps Gas chamber Gas van Holocaust train Human medical experimentation Zyklon BAftermath, trials and commemoration Aftermath Holocaust survivors Polish population transfers (1944–46) Bricha Kielce pogrom Anti-Jewish violence, 1944–46 Ministry of Public Security Trials West German trials Frankfurt Auschwitz Trials Treblinka trials Polish, East German, and Soviet trials Auschwitz trial (Poland) Stutthof trials Extraordinary (Soviet) State Commission Memorials Museum of the History of Polish Jews Auschwitz-Birkenau State Museum Majdanek State Museum Sobibór Museum International Youth Meeting Center in Oświęcim/Auschwitz March of the Living Righteous Among the Nations Polish Righteous Among the Nations Rescue of Jews by Poles during the Holocaust Garden of the Righteous Authority control GND: 4133156-4This article is issued from Wikipedia - version of the 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what are the core measures for hospitals?

Core measures show how consistently hospitals give recommended treatments for certain common conditions. The most commonly used and compared nationally are the core measures established by the Joint Commission based on data from the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid.

Core Measures

Core Measures

Core measures help identify which aspects of a hospital's care need improving, and they can give you important insights into a hospital's ability to manage specific aspects of a disease. Heart attack core measure set For a patient who is in a hospital because of a heart attack, this set of measures looks at whether that patient received the appropriate related drugs, education and testing, and whether these actions occurred within certain time frames. This measure indicates that 100 percent of patients treated for a heart attack at Rush receive these actions within the appropriate time frames. The higher the score on this measure, the better. For this measure, Rush scores better than the University Health System Consortium median for academic medical centers. Surgical complication prevention core measure set For a patient who is in a hospital because of a surgery, this set of measures looks at whether actions designed to decrease or prevent complications related to that surgery (for example, giving antibiotics to prevent infections) were completed within the recommended time frames. This measure indicates that actions designed to prevent complications related to surgery occurred within required time frames in 97.4 percent of patients who had surgery at Rush. The higher the score on this measure, the better. For this measure, Rush scores higher and therefore better than the University Health System Consortium median for academic medical centers.


is testosterone controlled

With the passage of the Anabolic Steroid Act of 1990 Congress bypassed the usual regulatory process (which a few years earlier under the Reagan Administration concluded that anabolic steroids should not be classified as controlled substances) that determines which drugs should be controlled, and concluded that testosterone and other anabolic steroids be classified as controlled substances.

"Why is Testosterone a Controlled Substance? December 21, 2011 By Dr. Joe Jacko 6 Comments Share Tweet Share Share Share Mail Print Testosterone a Controlled Substance: Why? Did you know that as you read this your body is manufacturing a substance that the U. S. Congress has determined to be a controlled substance? How can a hormone that the body naturally makes, not only in men, but also in women and children be considered to be dangerous enough to classified as a controlled substance?

What few realize is that leading up to those Congressional Hearings the AMA, FDA, and DEA all opposed the classification of anabolic steroids as controlled substances – because they did not meet the criteria of the Controlled Substances Act. Controlled Substances Act The original purpose of the Controlled Substances Act, which was passed in 1970, was to provide more strict legislation related to the prescription and distribution of drugs that are principally psychoactive and which are abused exclusively by virtue and because of their psychoactive (mind-altering) effects. Anabolic steroids were NOT categorized as controlled substances when the Act was passed in 1970 and were only included in 1990 despite little new information about them being learned. Though anabolic steroids are sometimes abused (as are many other drugs that are not controlled substances), they are not abused for their psychoactive effects. Psychoactive drugs include narcotics, hallucinogens, stimulants, and depressants. Congressional Hearings The Congressional Hearings that led to Anabolic Steroid Act of 1990 were convened to deal with the use of anabolic steroids in sports. At the time there was a growing concern in sports related to athletes cheating by using anabolic steroids. It should be pointed out that a substance does not need to be controlled for a sport to ban it if it so chooses. In fact, many drugs banned in sports are not controlled substances. For instance, beta-blockers which slow the heart rate (used for blood pressure and heart disease) are banned in archery. Archers will use beta blockers to slow their heart rate enabling them to shoot an arrow in between heart beats as the vibration of the heart beat is enough to throw them off target with their aim. In the case of anabolic steroids the last straw was when it was discovered the Canadian sprinter Ben Johnson tested positive for anabolic steroids in the 1988 Olympics and was stripped of his gold medal. There was a huge outrage and the general feeling that something must be done to curb such cheating in sports (though some have made some reasonable persuasive arguments that performance enhancing drugs should be permitted in sports if athletes choose to use them – click here to see such an article). Rick Collins is considered the foremost legal authority on anabolic steroids in the United States. In testimony as part of a federal hearing in 2005 he made 10 points in which he provides interesting comments, observations, and distinctions between anabolic steroids and other controlled substances. His comments will challenge those who believe anabolic steroids are as dangerous as the media and government reports. His 10 points begin on page eight of the following transcripts from a public hearing on April 12, 2005 in front of The United States Sentencing Commission. Article found here: USSC April 12 2005 Collins Anabolic Steroids. Medical Evidence: Little Presented at Congressional Hearings Between the Senate and House of Representatives hearings that led to the Anabolic Steroid Act of 1990 there’s about 500 pages of testimony of which only 50 or so deal with the medical evidence. In those days no randomized controlled studies existed on anabolic steroids, and back then and as is still the case today, there were no long-terms studies to guide any decision-making. The only evidence available were “expert opinion” and case studies, which are considered the two lowest levels of evidence when judging medical information. In his testimony to Congress, Charles Yesalis, Ph D and the leading epidemiologist at the time in the area of anabolic steroids intimated that a reason a long term study has not been performed on the safety and risks of anabolic steroids was the fear that such a study would show that anabolic steroids are not as dangerous as the medical community wants society to believe possibly fueling further abuse. How revealing. Having read the many pages of testimony at these Congressional Hearings it is my conclusion that the impetus to curb cheating in sports was strong enough that Congress relied on weak medical evidence to ascribe a legal remedy to what ultimately is an ethical issue – cheating in sports. The unfortunate result is the Anabolic Steroid Act has created the perception that testosterone is dangerous even for legitimate medical purposes leading physicians and patients away from using testosterone. Testosterone is safe when prescribed by a knowledgable physician and under close medical supervision, but synthetic anabolic steroids do carry some health risks. So there is a distinction between testosterone – the stuff your body makes – and synthetic anabolic steroids abused by athletes. In some countries testosterone can even be obtained over the counter without prescription (Mexico, Portugal, Netherlands). Since those hearings several randomized controlled studies have been performed using testosterone (not synthetic anabolic steroids) in supra-physiologic doses, the landmark study being Bhasin’s study published in the New England Journal of Medicine in 1996. This and other studies have shown that even in doses 6 to 10 times normal testosterone is relatively safe in an injectable form, though there can be transient laboratory abnormalities that resolve generally within 3 months of discontinuation of high dose testosterone use. Such laboratory abnormalities are far less frequent when physiologic or normal doses are used. When properly prescribed and used testosterone is safer than most prescription and over the counter medications which are completely foreign to the body. This includes aspirin, ibuprofen, and acetaminophen. It is safer than birth control pills. It is safer than smoking and alchohol and recreational drugs. And, it is far safer than chemotherapy agents used in cancer treatments and the many new biologics now used to treat autoimmune diseases. So why is testosterone a controlled substance? In my opinion, to curb cheating in sports (yet few elite athletes have ever been prosecuted). The people being prosecuted are the those in the gym trying to improve their health and fitness. Unfortunately, in the process we have allowed what a few thousand professional athletes can and cannot do potentially affect the health of those in the general population who may be testosterone deficient. For a more detailed appreciation of the history behind the Anabolic Steroid Act of 1990 we recommend you read Legal Muscle: Anabolic Steroids in America by Rick Collins. This article was updated 5/7/16. To learn more about the benefits of testosterone read the following the articles found on this website:“Does Testosterone Reduce Inflammation?”“Low Testosterone Symptoms”“Treatment for a Low Testosterone Level”“Hormone Replacement for Men”“Nonsexual Symptoms of Low Testosterone” (Visited 8,836 times, 5 visits today)Share Tweet Share Share Share Mail Print Legal Muscle: Anabolic Steroids in America Legal Muscle: Anabolic Steroids in America If you want to learn about the law surrounding anabolic steroids. If you want to learn the history of how anabolic steroids including testosterone, a substance all humans make, become controlled substances (the only controlled hormone). If you want to learn about the true…January 24, 2016In ""Book Reviews""Is Testosterone Dangerous as TV Commercials and Ads Say it Is? June 4, 2014In ""Men's Health""My Journey Into Anti-Aging Medicine""Hey Dr. Joe, how did you get interested in anti-aging medicine"", I'm occasionally asked by patients. Well it was quite unexpected. I had a very nice career practicing sports medicine and wasn't looking to do anything different. But, that started to change in February 2007. Here's my story. In 2007 I was…May 3, 2015In ""Men's Health""Related posts: Erectile Dysfunction How to Increase Testosterone Levels Does Testosterone Reduce Inflammation? Testosterone: To Tell The Truth "


what does humus do to soil?

Generally, with higher levels of humus in the soil it takes less nutrients to produce a pound of produce. In other words, the system becomes more efficient. I have recently checked 350 soil samples that I received and many of the first and second year clients have very low humus readings.

Humus

"Humus I have done a lot of humus tests lately using the Lamotte Soil Humus Screening Test. The results have been very interesting and informative. At least 90% of the soils tested the past four years have shown a high humus reading based on the Lamotte method. The soils that didn't respond must have some problems that still need work. I wish that I had a 90% success rate on a lot of other things I have done in life. The question now becomes, ""What does this mean?"" I believe this means the potential for better quality in the crops produced. Quality is often talked about, yet hard to define when speaking of grains, fruits and vegetables. To me, better quality means better shelf life of fruits and vegetables, higher oil content of grains, well defined flavor, rich color, high weight per volume and a high sugar content. Humus increases mineral availability to plant rootlets Humus is that fraction of the soil medium which aids in making minerals available to plant rootlets. The principle components of humus are a group of humic acids which have very unique properties. The best description I can use to describe humic acids is, ""oscillating catalysts."" This means they can work over a wide range of soil conditions and still be effective. For example, there is a chart published which shows the optimum p H range in which basic elements for plant growth are most readily available. This holds true in low organic matter and low humus soils. The minute you introduce different levels of humus into a soil these ranges change. This area has been studied by researchers for some time with little or no results due to the fact that the humic acids don't respond in solutions and under conditions of conventional chemistry like other acids. Humic acids of different types have a high buffering capacity. Since humic acids don't work well in the bounds of conventional chemistry many researchers have quit pursuing this area. It is only recently that humic acids are being looked at again. Higher levels of humus in the soil = less nutrients needed to produce a pound of produce

The scale used by the Lamotte test runs from 1-5 with 5 being the highest humus reading. Humus is produced in the soil by the proper decay of animal and plant matter. The principle component of humus is carbon. The color ranges from a light brown to a dark brownish-black. In order to build humus levels in soil the proper ratio of water, air, residue, bacteria, protozoa, algae, yeasts and fungi are needed. Use of acid and salt based fertilizers in excess of the soil's ability to neutralize them results in lowering, rather than building, the amount of humus in the soil. The lower the humus becomes the more often the soil needs rain to maintain a crop. The soil that contains a good humus level stabilizes moisture availability and the soil more readily draws humidity from the air at night. Humus increases the strength of the electromagnetic power of the soil resulting in the faster plant growth. I observed a field last year that was entirely planted in one day. After 2 weeks one part of the field had nearly 2 inches more growth than the other. This result may not be due to humus, but it sure could be a factor. Humus certainly affects soil tilth and makes the soil much easier to till. I also have observed less problems with weed control as the humus rises along with the calcium. Sugar levels A factor that is seldom discussed in soil fertility is sugar levels. As the sugar and humus levels rise in soil, along with calcium, weeds become much easier to manage and the need for herbicides is greatly reduced. I have had several telephone conversations relating to the use of sugar and the reduced incidence of weed control problems. I wish more research would be done in this area. The one thing I find most interesting is the higher the humus the less grass problems a field seems to have. If you look at the root systems of grasses and the root systems of broad leaves, you will notice quite a difference. Grasses are generally more of a problem in tight, compacted soils and broad leaves in looser soils that are deficient in a specific trace mineral. If conditions are right for humus development in a soil, the hard pan often seen in soils under heavy crop reproduction has a tendency to dissipate, which further helps the movement of water up and down. It has been very interesting watching humus levels rise in the soils on which I have been working, and yet not always understanding why. Calcium and magnesium levels The first thing I look at in my soil tests is the calcium and magnesium levels. If the ratio is very narrow you nearly always have a tight, compacted soil. I like to see the ratio of calcium to magnesium greater than 5:1 and closer to 7:1. If the ratio is narrow and it is fall, I will recommend a liming program. If it is spring, I would generally recommend the use of liquid calcium products of which there are many on the market and all are very good. If you are purchasing a liquid calcium product be sure to find out if sugar has been added. If not, apply sugar at the same time. I have recommended this many times and often see a dramatic increase in calcium after a short time. It's not uncommon to have a calcium reading of 1,000-1,200 lbs. and 4 to 6 weeks later see readings of 2,000-3,000 lbs. per acre or more. Many would ask how this could possibly happen. Calcium can be tightly bound to clay and silica particles in soil and thus not show up in a regular soil test. The action of bacteria can release this bound calcium into the soil medium and make the calcium readily available to the plants. One of the key ingredients is a source of energy for the soil bacteria and I find 4-6 lbs. of table sugar works very well to accomplish this task. Actually, most any type of sugar will do. The liquid calcium is also very important because, just like any other animal, the number one mineral needed by bacteria is calcium. The activity of the calcium, sugar, and bacteria start to mellow a soil, increasing the air and water holding capacity. Once bacteria become active, the electromagnetic field in soil starts to rise. The reason is that all living things carry an electric charge and bacteria are no exception. Bacteria are also sticky and can cause soil particles to clump together causing a granular consistency. This helps air and moisture movement through the soil, allowing the bacteria to get needed nutrients from the air. It is very important to get this cycle established in a soil so that you build humus and electromagnetism in a soil. This stronger the electromagnetism, the greater the oil content of crops and density of produce raised. The more energy in produce, the healthier it is for whoever consumes it. What we really need is some accurate feeding trials to know the economic impact. I know quality grain can make a difference but the question is, ""How much? ""Fish meal, liquid fish, and dry, water soluble fish I have also found fish meal, liquid fish, and dry, water soluble fish to be a very valuable source of plant food used in an overall soil program. I like to use liquid fish with liquid 28% nitrogen in preplant broadcast programs and side dress programs. Fish contains a good spectrum of trace minerals, amino acids, vitamins and enzymes. Fish also has quite an impact on insect damage when sprayed on crops. The impact of this will not occur the first or second year after coming off a conventional program and I am not sure why. After this period of time, spraying with a mixture of liquid fish and seaweed seems to really have an impact on insects. I like the dry, water soluble fish for foliar applications because of the fine particle size and enzyme content. The use of these products seems to mellow a soil faster and increase the humus content. The sooner the humus content rises, the greater the chance of surviving a dry spell. Yields and pay back, use of Nitromax I have been asked many times about yields and pay back with this type of program. The first two to three years I don't see much in increased yields, only more nutrient level per pound of produce. Once the soil is built up, then yields should start to rise. The big benefits in the end are less erosion and pollution, and the soil is easier to work. I also work quite extensively with a product call Nitromax and find it to be an excellent product if you know how to use it. It works very well into programs along with manure and not so well in heavy, tight soils with no manure. If you have heavy, tight, clay soils that lack air, the results the first year or two will not be very good. If you are going to use Nitromax under these conditions be sure and use a soil conditioner along with Nitromax. Nitromax contains cytokinins that affect soils in such a way to produce their own nitrogen. The results are usually much better in lighter soils than in heavier soils. I often find increased nitrogen levels above and beyond controls if Nitromax kicks in. Nitromax frequently brings the p H to around 6.8 unless some basic elements are very deficient. Like most products it takes careful management and planning to make it a success. For some reason, when using this product, the calcium to magnesium ratio widens, which helps grass control and soil compaction. It is very convenient to use and mixes very nicely with liquid nitrogens. I always want to see the product broadcast on the whole acre, not just part of the acre. Nitromax has long running case histories of increasing the soil organic matter the first year one-half percent, one-half to one percent the second year, and one to two percent the third year. The success or failure is dependent on the availability of soil calcium. So far I have been finding it working quite successfully on my own farm. Currently the organic matter is over five percent and calcium running 3,500-4,000. I have added 200 lbs. per acre of hi-cal lime the last two years along with Nitromax and have seen the calcium rise from 1,100-1,200 lbs. per acre to over 3,000 lbs. per acre and the organic matter rise 11/2 percent. The yields have been at the top for the area. The soil tilth is excellent and weed control very easy. Most well managed programs don't see dramatic yield increases but rather increased quality as shown in higher levels of zinc, iron, copper, cobalt, calcium and phosphorus in the grains or vegetables. I just hope more people become aware of these things and premium markets are established. Fish Analysis Total Protein, % 32.73 Aluminum, PMM 226.81Moisture 49.88 Barium 4.52Fat 6.87 Iron 521.66Ash 7.94 Strontium 2.97Calcium 0.07 Boron 3.00Phosphorus 0.69 Copper 15.77Potassium 1.53 Zinc 17.31Magnesium 0.11 Manganese 7.30Sodium 1.28 Chromium 1.31Selenium 1.77Amino Acids As % of Sample Lysine 1.61 Alanine 1.93Histidine 0.80 Valine 0.86Arginine 1.32 Methionine 0.50Aspartic Acid 1.80 Isoleucine 0.66Threonine 0.77 Leucine 1.37Serine 0.86 Tyrosine 0.37Glutamic Acid 2.97 Phenylalanine 0.72Proline 1.48 Tryptophan 0.09Glycine 2.83 Cystine 0.15Vitamins, MG/LB., Literature Values Riboflavin 5.72 Biotin 0.06Niacin 78.38 Folic Acid 0.09Pantothenic Acid 16.10 Thiamine 2.27Choline 1537.25 Pyridoxine 5.49Vitamin B12 0.23D. L. Skow D. V. M. "


when is the real id required to fly

And, as of Oct. 1, 2020, all air travelers will be required to have a Real ID-compliant driver’s license or alternate acceptable identification to fly domestically. What exactly qualifies as acceptable identification?

Travel What You Need to Know About the New ID Law and Travel By SHIVANI VORA NOV. 8, 2017A Hilton Passport Project booth at O’Hare Airport in Chicago. Dan Boczarski/Getty Images In the past several months, there has been plenty of conversation about the Real ID Act and how it will affect air travelers. Passed by Congress in 2005, the act is intended to prevent identity fraud, and starting on Jan. 22, 2018, fliers who reside in some states, even if they’re flying domestically, will need identification other than a driver’s license to pass through Transportation Security Administration security checkpoints at airports. Who exactly is affected and what additional identification will the T. S. A. require? Here, answers to questions about what the Real ID Act means for travelers and why having a passport now may be more important than ever. What exactly is the Real ID Act? The act is meant to ensure that a person presenting an ID is in fact who that person says they are, according to Justine Whelan, a spokeswoman for the Department of Homeland Security.“The act prevents the production of fake IDs and ensures that all identification that is used has certain features which prevent tampering or are difficult to replicate,” Ms. Whelan said. These features include anti-counterfeit technology, such as the holograms on some state licenses. Federally issued documents, such as a passport, also fall into the difficult-to-replicate category. Why is the act being implemented? Congress passed the act on the recommendation of the 9/11 Commission that the federal government set minimum security standards for how states issue identification and for how that identification is used. “These security standards ensure a safer American public. At the end of the day, everyone should be who they say they are,” Ms. Whelan said. Related Coverage TRAVEL TIPSWhat You Need to Know About Your Passport JUNE 6, 2017TRAVEL TIPSHow to Get Your Passport in Order JULY 1, 2016Smarter Living Stories to help you understand the world – and make the most of it. Why Is the Greatest Love of All Also the Hardest? APR 103 Steps to Avoid Giving Biased Feedback APR 8Do Your Taxes. Then, Read These Books APR 5How to Do Laundry APR 5Six Simple Tips for Smooth Travel With a Disability APR 5See More »When does it go into effect and for which states? Ms. Whelan said that Real ID enforcement has been implemented in phases over the last two years in some states. If you show up to a federal facility such as a military base, for example, and you live in a state that’s not Real ID compliant, you will need alternative identification to a driver’s license. Currently, 28 states are Real ID compliant, including Texas, Ohio, Florida, Nevada and Colorado. For a complete list, visit dhs.gov/real-id. But what does the Real ID Act mean for air travelers? Starting Jan. 22, 2018, the T. S. A. will ask all travelers who don’t have a driver’s license from a compliant state or a state that has been granted an extension to the compliance deadline (this means that residents can continue using their noncompliant license for federal purposes while the state continues working to be in compliance) to provide an alternative form of acceptable identification. Travelers won’t be able to pass through security without this acceptable identification.

The D. H. S. has designated more than a dozen forms of acceptable ID including a passport; a border ID card; a trusted traveler card, such as Global Entry; a Real ID compliant driver’s license; and a permanent resident card. For a complete list, visit tsa.gov/travel/security-screening/identification. Travel Dispatch Every Saturday, get travel tips, destination coverage, photos from all over the world and more. Sign Up You agree to receive occasional updates and special offers for The New York Times's products and services. I'm not a robotre CAPTCHAPrivacy - Terms See Sample Privacy Policy Opt out or contact us anytime Is one form of acceptable identification better than another? Ms. Whelan said that the D. H. S. does not advocate any particular form of acceptable identification, but Brenda Sprague, who oversees passport services for the U. S. Department of State, said that, with the implementation of Real ID fast approaching, residents who live in states that aren’t Real ID compliant should apply for a passport before the end of the year. November and December are the best months to apply for or renew your current passport, Ms. Sprague said, because the turnaround time to get a new passport now is usually around four weeks. In the summer, when passport applications peak, the wait for a new passport could be up to eight weeks. Around 136 million Americans have passports in circulation, according to State Department — that’s only around 40 percent of the population in the United States. O. K., you’ve convinced me, and I’m ready to apply for a new passport. What’s the best way? Ms. Sprague said that there are more than 8,000 passport application locations around the country. Around 60 percent are post offices while the rest are courthouses and libraries. Visit the Department of State’s Where to Apply link for more details. In addition, there are 27 passport agencies, where travelers can apply for rush passports. “These agencies are for people who are traveling within two weeks,” Ms. Sprague said. This link has a list of these agencies; applicants need an appointment for a visit and can make one online at passportappointment.travel.state.gov. Also, the State Department is collaborating with Hilton Hotels & Resorts on the Hilton Passport Project, an initiative meant to encourage more Americans to apply for passports. Every few weeks, a Hilton location in the United States will have a Passport Concierge booth, where guests and the general public can have their passport pictures taken for free and apply for or renew a passport. Between one and three employees from the State Department will be on hand to answer passport-related questions and help fill out applications. The next Passport Concierge will be at Hilton Cleveland Downtown from Nov. 9 to 11. For a list of coming locations, visit facebook.com/Hilton. How much does it cost to get a new passport? First-time applicants pay $110 plus a $25 application fee. Passport renewals cost $110 and expedited passports are an additional $60. If you’re renewing your passport, you can do it by mail, but if you’re getting a new passport or if your existing one is lost or stolen, you must apply in person. Correction: November 8, 2017 An earlier version of this article incorrectly listed states that currently are Real ID compliant. A version of this article appears in print on November 19, 2017, on Page TR4 of the New York edition with the headline: Future of Air Travel: Preparing for the Real ID Act. Order Reprints Today's Paper Subscribe