The historiography of sterilization and “euthanasia” in the Third Reich is now extensive, though somewhat fractured into local and narrowly tailored studies. One of the great benefits of Matthias Klein's well-researched dissertation is how it weaves together material from a range of histories. The focus here is the mostly rural and majority-Catholic region of Trier, but the author carefully compares his findings with evidence from other regions and explores the relevance of his conclusions to broader historiographical questions. The result is a local history that will be useful to anyone interested in Nazi racial hygiene.

Recent histories have stressed the relative autonomy of regional authorities in implementing the sterilization program. This work adds to that picture. Across Trier, local health officers played the leading role in bringing cases before the hereditary health courts. Youth welfare officials, private physicians, and the directors of prisons and psychiatric institutions assisted in identifying candidates for sterilization. The courts themselves were staffed by local doctors and jurists, who were unabashedly self-assertive when they disagreed with petitioners (more than 20% of applications for sterilization were rejected) but clearly supported the racial hygienic goals of the regime. Over 2200 persons were ultimately sterilized in Trier, about one-half of 1% of the total regional population, consistent with national trends. (See also Michael Burleigh and Wolfgang Wippermann, The Racial State [1991].)

How did local officials in Trier reconcile their participation in the sterilization program with their Catholic faith? And how did Catholic institutions navigate their conflicting obligations to church and state? In a 1933 circular, the Trier Diocese called upon Catholic institutions to refuse any involvement in the sterilization program. Less than six months later, however, provincial bishops meeting in Cologne allowed that Catholics could, in good conscience, notify the medical authorities of individuals suspected of being hereditarily ill, though they must not petition for their sterilization before the hereditary health courts. This distinction between notifications (Anzeige) and petitions (Anträge) was intended to prevent Catholic functionaries from running afoul of the law which, starting in December 1933, obligated the reporting of potential candidates for sterilization. In practice, the church's stance provided moral cover for those who were eager to assist in the sterilization program. The director of the Catholic mental hospital in Trier referred not only scores of inmates to the local health authorities but also his private patients and even visitors to his office hours. Under his leadership, the hospital also filed more than one hundred petitions for sterilization, in seeming defiance of the bishops’ order. The warden of the local prison, on the other hand, an ordained priest, asked the diocese for explicit permission to delegate the issuing of petitions for sterilization to his non-Catholic deputy. The diocese agreed, paving the way for dozens of prisoners to be brought before the hereditary health courts.

According to Klein, the church's protest against the sterilization law petered out in the early years of the Third Reich. In a pastoral letter of 1934, the Bishop of Trier referenced the pope's condemnation of sterilization in his 1930 encyclical and regretted the “confusion” (236) which had taken hold in the German people. Such allusions to the sterilization program subsequently disappeared from the bishop's communiques, even as he condemned various aspects of Nazi policy toward the church. Catholic opponents of National Socialism included sterilization among the list of reasons that voters in the neighboring Saarland should reject the referendum on rejoining the Reich, but the issue evidently found less resonance in the propaganda of resistance within Germany.

Klein's case study of the implementation of the Hereditary Health Law in Trier challenges arguments that the Catholic Church became more unified in its opposition to racial hygiene as the radical nature of Nazi policy became apparent. (See also Ingrid Richter, Katholizismus und Eugenik in der Weimarer Republic und im Dritten Reich [2001].) Klein suggests that historians look more carefully at the role of Catholic institutions in facilitating sterilization. It is possible that the legacy of eugenic thinking within the Catholic Church was more lasting and more consequential than has been previously acknowledged.

Klein's discussion of the mass murder of Trier patients is less conclusive and less compelling. More than 500 patients from two Catholic institutions in Trier were transferred from the region. Around half of them died during the war, either in the T4 program or while confined in institutions scattered around Germany. Klein explores various possible motives for the evacuation from Trier and concludes, somewhat shakily, that it was due to military preoccupations. He reaches no conclusions concerning the extent to which citizens in Trier knew about the fate of the ninety patients sent to the gas chambers. He takes a similarly cautious stance regarding whether the 130 former Trier patients who died in institutional settings were deliberately murdered by neglect and deprivation.

More research will be required in order to reach definitive conclusions on these latter questions. This study should be praised for carefully setting the stage for future work.