Wegener's granulomatosis--probing the untold past of the man behind the eponym

In 1936, Friedrich Wegener described cases of a peculiar small-vessel vasculitis with granulomatous inflammation [ 1 ]. Particularly with the publication of a review of 22 cases and seven of their own by Godman and Churg [ 2 ] in 1954, the disorder became more widely known as Wegener's granulomatosis. Wegener faded into obscurity until the 1980s, when he began to receive more personal attention until his death in 1990. The life of Friedrich Wegener has been described in great detail [ 3 ] but his involvement with the Nazi regime remained little known until very recently [ 4 ]. Here, we describe the process of research that led to these discoveries about his past and provide more details about it. We also discuss the continued use of the eponym. In summer 2000, Lancet ' s newly created ‘Eponyms’ section prompted us to write an article on Friedrich Wegener. We compiled material from a book in German [ 3 ] and several articles, most of which were obituraries published after Wegener's death in 1990 [ 5 ]. We submitted the article on 27 September 2000. On 7 December 2000, we received a decision of ‘not acceptable in present form’. We were devastated to read the Lancet ' s letter: ‘We understand that he was imprisoned after the war for activities undertaken under the Nazi regime, and that was why he was not practising as a pathologist.’ Most documents about the Nazi regime are available through the German Federal archives; its Berlin branch hosts the largest number of files by far, including the files of the former Berlin Document Center (BDC). Military files are stored in Freiburg and records of trials are housed in Ludwigsburg. It turned out that Wegener joined the National Socialist German Workers Party (NSDAP) on 1 May 1933. Surprisingly, Wegener had become a member of the ‘Sturmabteilung’ (SA), the brownshirts of the early Nazi movement, as early as in September 1932, eight months before the Hitler regime seized power. Wegener rose within the ranks of the SA and became a lieutenant colonel in the medical corps in 1938 [ 6 ]. From military files in Freiburg, we learned that Wegener had arrived in Lodz in 1939 to serve primarily as a military pathologist. Later, he became attached to the ‘Gesundheitsamt’, the health office of the local civil municipal authority [ 7 ]. We obtained the 1943 payroll documents showing that Wegener was indeed listed under the heading of ‘Prosektorium’ (autopsy facility). From the payroll lists, we also set out to find contemporaries of Wegener by searching for staff with uncommon surnames who might still be alive and whom we might have a better chance of locating. We identified an Eleonore Dietze, who had been Wegener's secretary from 1941 to 1943. We traced a number of Eleonore Dietzes through the German telephone registry and found Friedrich Wegener's former secretary in a nursing home in Zeitz, Germany. Unfortunately, due to her dementia, Mrs Dietze was unable to recall any events from the Lodz period. We found no evidence that Dr Wegener stood trial after 1945, nor evidence that he had been imprisoned or banned from the medical profession. We managed to obtain Wegener's de-nazification file from the state archives in Schleswig-Holstein in which witnesses paid testimony to Wegener's conduct during the Nazi regime. It is difficult, though, to come to any conclusion, since many of these testimonies were less than complete and truthful. Among others, we also requested help from the Simon Wiesenthal Foundation and the Yad Vashem Archives in Israel, all to no avail. We also searched the National Archives and Records Administration (NARA). According to their files, a note card suggested that Wegener may have worked at the Auschwitz concentration camp, but there were no primary files to confirm this [ 8 ]. A search at the Public Records Office at Kew Gardens, UK, yielded no results. Dr Friedrich Wegener. We first sought help from the Polish institute for the Prosecution of German War Crimes (IPN). In March 2002, we were notified by IPN head office that Wegener had appeared on a wanted list compiled by the Polish Ministry of the Interior. On this card, reference was made that Wegener's file had been forwarded to the United Nations War Crimes Commission (UNWCC) on 16 May 1944. His name is misspelled (‘Wegner’ instead of ‘Wegener’), but the card clearly denotes him as the Director of the Pathological Institute in Lodz. Interestingly, the misspelling appears in many places, including Wegener's military registration card. A number of Wegeners appear on the UNWCC, but it was impossible to link any of these entries to Dr Friedrich Wegener, particularly because many them lacked a date of birth or further details. Many versions of these lists were compiled by Allied Forces and that most of the persons named were never prosecuted or even located. Notably, the IPN confirmed that Wegener had appeared on the central list of war criminals and security suspects (CROWCASS, Part 1, 1948), but we were unable to trace the original list. We then tried to find Wegener's file within the IPN archives in Poland. We learned that his file had been requested by a court in Lodz during a trial about war crimes in Piotrkow, a small city some 40 miles from Lodz. At the same time, IPN archives had apparently undergone reorganization and his file had been lost. Despite all attempts, we were unable to retrieve this IPN file from Polish archives or even locate the files of the Piotrkow trial. Next, we travelled to Lodz and searched the local archives. We discovered the monthly reports from Dr Friedrich Wegener to his superiors at the ‘Gesundheitsamt’, the municipal health authority. For instance, 172 autopsies were performed between 1 September and 30 November 1941 [ 9 ]. Some entries provide a glimpse of the events at the Lodz Ghetto. For example, on 25 January 1941, Wegener reports on the corpse of a child who had died at the railway station during one of the deportation transports [ 9 ]. We also found a letter to the effect that Wegener trained doctors from the ghetto hospital in performing autopsies [ 10 ]. The ‘Gesundheitsamt’ mortuary had moved repeatedly during the years 1939–45 but had for some time been at Schneestrasse, which is today known as ul. Sedziowska. The building still exists and part of it houses the department of forensic medicine of the Lodz Medical Academy. Notably, the building is very close to the borders of the former Jewish Ghetto as can be seen from a map of the ghetto [ 11 ]. Among the IPN files, we found five registry cards with references. We traced all of them and found, among the files of the German regional government in Poznan, a letter by Dr Friedrich Wegener. The file holds a solitary letter by Dr Wegener, written to an unknown recipient in 1944, in which Wegener stated, ‘Today, your manuscript about your work on air embolism has arrived safely in my institute. I hope I will be able to concern myself with this matter in greater detail in the near future’ [ 12 ]. The ‘Warthegau’ regional government was located in Poznan and some official within the Medical Division of that government may well have been the recipient of the letter. This assumption is strengthened by the fact that all accompanying letters within this file and the rest of the letter pertain to matters of municipal health and hygiene, particularly the conduct of autopsies. Air embolism was a rare phenomenon at the time and almost exclusively observed after septic abortion. Notably, air embolism was a feature of the notorious high-altitude experiments conducted by Nazi physicians [ 13 ]. These experiments were mainly conducted at the concentration camp in Dachau in Southern Germany and many victims were members of Polish clergy. We found no evidence to prove the active participation of Dr Wegener in such experiments. In addition, we were unable to prove that such experiments were ever conducted within the ‘Warthegau’. After the German 1939 invasion, Lodz was renamed Litzmannstadt and became a key city for the ‘Warthegau’ area of the annexed Western Poland. A ghetto for Jews, many of whom were brought there from Germany proper, was established. In 1940, some 250 000 people lived there under appalling conditions [ 14 ]. It must be noted that the ‘Warthegau’ was intended to serve as a model area of German occupation. Accordingly, German authorities wished to turn the ‘Warthegau’ into a spearhead of the genocide [ 15 ]. Ghetto inmates were selected for deportation to the nearby concentration camp in Chelmno and died there, mainly by carbon monoxide poisoning in converted buses. The local health authorities were deeply involved in the process of ghettoization and selection [ 16 ] although few perpetrators faced trial [ 15 ]. There is evidence that, at least occasionally, victims of these transports were autopsied by Wegener [ 9 ]. Officials of the racial and heriditary hygiene at the ‘Gesundheitsamt’, particularly Drs Grohmann and Kleebank, have been implicated in the killings of hospital inmates [ 15 ] and the 1941 payroll confirms that Wegener was their contemporary. It has been emphasized that crimes in the ‘Warthegau’ have received less than appropriate attention [ 15 ]. The loss of many documents around the end of World War II may offer some explanation for this lack of prosecution. An NSDAP member since 1931, Staemmler (1890–1974) was appointed chair of pathology in Kiel in 1934 and thus became Wegener's academic mentor. Later, Staemmler was appointed head of the Department of Pathology at the University of Breslau and took Wegener with him. An ardent supporter of the Nazi regime [ 17 ], Staemmler was appointed there with political purpose. Government officials planned to turn the city's university into a ‘Reichsuniversität’ and model institution, and therefore chose an appointee with strong ties to the national socialist regime: ‘Staemmler […] belongs to those first university professors who came to Hitler. Professor Staemmler has also served the national socialism by giving talks […]. His book “Rassenpflege im völkischen Staat” is widely known.’ [ 17 ] Prof. Dr Martin Staemmler. The role of physicians during the Nazi regime has been highlighted previously [ 20 , 21 ]. The facts we have uncovered do not prove Dr Friedrich Wegener guilty of war crimes. However, the evidence suggests that Dr Wegener was, at least at some point of his career, a follower of the Nazi regime. Dr Wegener's mentor, Martin Staemmler, was an ardent supporter of the racial hygiene. In addition, our data indicate that Dr Wegener was wanted by Polish authorities and that his files were forwarded to the United Nations War Crimes Commission. Finally, Dr Wegener worked in close proximity to the genocide machinery in Lodz. His interest in air embolism is also troubling. Although we know that Wegener was a popular and skilled teacher and colleague, our data raise serious concerns about Dr Wegener's professional conduct. We suggest that the eponym be abandoned and propose ‘ANCA-associated granulomatous vasculitis’ as an alternative. We are indebted to all the people who have supported this difficult work through the years 2000–06. The authors have declared no conflicts of interest.