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InstructionsRead The Clara Cell: A “Third Reich Eponym”‘? (attached), a scholarly article chronicling an ethical conflict from World War II. Identify and describe the central ethical conflict of the case. If Max Clara and his research had been subject to the APA Code of Ethics, explain what principles and standards would have been violated. What are the ethical implications of making a moral judgment on past actions by researchers? For additional details, please refer to the Module Three Short Paper Guidelines and Rubric document (attached).Please see the attached requirements and follow them exactly!
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Eur Respir J 2010; 36: 722–727
DOI: 10.1183/09031936.00146609
CopyrightßERS 2010
HISTORICAL PERSPECTIVE
The Clara cell: a ‘‘Third Reich eponym’’?
A. Winkelmann* and T. Noack#
ABSTRACT: German anatomist Max Clara (1899–1966) described the ‘‘Clara cell’’ of the
bronchiolar epithelium in 1937. The present article investigates Clara’s relationship with National
Socialism, as well as his use of tissue from executed prisoners for research purposes, details
about both of which are largely unknown to date. Our methodology for the present study focussed
on analysis of material from historical archives and the publications of Clara and his co-workers.
Clara was appointed as Chair of Anatomy at Leipzig University (Leipzig, Germany) in 1935. He
owed his career, at least in part, to Nazi support. He was an active member of the Nazi party
(Nationalsozialistische Deutsche Arbeiterpartei (NSDAP)) and engaged in university politics; this
included making anti-Semitic statements about other academics in appointment procedures.
Nevertheless, he also supported prosecuted colleagues.
Much of Clara’s histological research in Leipzig, including his original description of the
bronchial epithelium, was based on tissue taken from prisoners executed in nearby Dresden
(Germany).
Max Clara was an active and outspoken Nazi and his histological research exploited the rising
number of executions during the Nazi period. Clara’s discovery is thus linked to the Nazi system.
The facts given in the present paper invite discussion about the eponym’s neglected history and
its continued and problematic use in medical terminology.
KEYWORDS: Bronchioli, Clara cell protein, histology, National Socialism, research ethics
n 1937, anatomist Max Clara described a new
secretory cell type in the human bronchial
epithelium [1]; this has been known as the
‘‘Clara cell’’ since at least 1955 [2]. With the
identification of a specific Clara cell protein
(CC10, identical to CC16 or uteroglobin) [3],
which may play a role as a clinical biomarker of
lung disease [4], and with the characterisation of
a Clara-like cell in neuroepithelial bodies of the
airway lining [5] in the 1980s, interest in the cell
and its function has intensified. The term ‘‘Clara
cell’’ has been in widespread international use
since that time (fig. 1).
I
At the same time, there has been considerable
interest in eponymous scientific discoveries by
researchers with a connection to Nazi Germany,
such as Hans Reiter [7], Friedrich Wegener [8],
Julius Hallervorden and Hugo Spatz [9]. It is
therefore surprising that Clara’s documented
support of the Nazi movement [10, 11] has not
drawn more attention, particularly as his oft-cited
original description [1] was based on tissue taken
from executed prisoners, a material source that is
dubious at best by today’s ethical standards. We
have therefore attempted to clarify Clara’s involvement in National Socialism and the ethical
context of the original description of ‘‘his’’ cell.
To our knowledge, no other eponym in respiratory medicine, with the exception of Wegener’s
granulomatosis (see Discussion), originated in
the Third Reich.
VOLUME 36 NUMBER 4
CORRESPONDENCE
A. Winkelmann
Institute of Cell Biology and
Neurobiology
Center for Anatomy Charité –
Universitätsmedizin Berlin
Schumannstr. 20/21
D-10117 Berlin
Germany
E-mail: [email protected]
charite.de
Received:
Sept 15 2009
Accepted after revision:
Feb 22 2010
First published online:
March 11 2010
METHODS
We examined relevant literature, documents held
in historical archives in Berlin, Leipzig, Dresden,
and Munich (all Germany), and the publications
of Clara and his co-workers. As some of the
documents referred to in this manuscript may be
difficult to find, these have been provided online
as supplementary material. The relevant references are marked with an asterisk (*). For all
For editorial comments see page 706.
As some of the documents referred to in this manuscript may be difficult to find, these have been provided as supplementary
material. The relevant references are marked with an asterisk (*). For all other documents of this kind, the reader should refer
to the institute holding the archive. Supplementary material is accessible from www.erj.ersjournals.com
722
AFFILIATIONS
*Institute of Cell Biology and
Neurobiology, Center for Anatomy,
Charité – Universitätsmedizin Berlin,
Berlin, and
#
Institute of the History of Medicine,
Heinrich-Heine-Universität
Düsseldorf, Düsseldorf, Germany.
European Respiratory Journal
Print ISSN 0903-1936
Online ISSN 1399-3003
EUROPEAN RESPIRATORY JOURNAL
A. WINKELMANN AND T. NOACK
HISTORICAL PERSPECTIVE
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2009
2007
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Hits n
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FIGURE 1.
He continued his histological research in his spare time and,
from 1929 on, also lectured in an unpaid position at the
University of Padua (Padua, Italy) [12].
In 1935, to the annoyance of established anatomists [13*], Clara
was appointed Chair of Anatomy at Leipzig University, and in
October 1942, assumed the prestigious position of Chair of
Anatomy in Munich, which he held until the end of the war.
Like many other Nazi Party members in public office, Clara
was arrested by the US army in October 1945 [14*]. After his
release in October 1946, Clara could not find a permanent
position at Munich University or elsewhere in Germany
despite many desperate efforts [15*]. His status within
German academia after 1945 seems to have been one of persona
non grata (dicussed further later). In 1950, he finally accepted a
professorship for histology at the University of Istanbul,
Turkey, which he retained until 1961 [16]. Max Clara died in
Munich in 1966.
Hits per year, during the period 1975–2009, for the term ‘‘Clara
cell’’ in the Medline database [6]. Of the 1,081 articles, only three were in German.
other documents of this kind, the reader should refer to the
institute holding the archive.
RESULTS
Max Clara’s career
Max Clara (fig. 2) was born in 1899 in a village near Bozen in
South Tyrol, then part of Austria. Having studied medicine in
Innsbruck, Austria, and Leipzig, Germany, Clara’s first
position was at the Institute of Histology and Embryology in
Innsbruck in 1923. After the sudden death of his father in 1924,
Clara left this post to carry on his father’s general practice in
his home village, which had come under Italian rule in 1919.
Clara and National Socialism
While Clara was undoubtedly an accomplished histological
researcher, he had virtually no experience in gross anatomy on
taking up his first professorship in Leipzig in 1935. Many
sources show that his striking career advancements in 1935
and 1942 were largely due to political support within the Nazi
establishment, including the SA (storm troopers) and Max de
Crinis, a prominent Nazi physician at the Ministry of Higher
Education [13*, 17*, 18*, 19, 20*]. De Crinis (1889–1945) held the
Chair of Neurology and Psychiatry of Charité Medical School
in Berlin from 1939. He was centrally involved in SS activities
and is widely regarded as a key figure in the Nazi
‘‘euthanasia’’ programme, in which tens of thousands of
psychiatric patients were murdered [21].
Immediately on arriving in Leipzig from Italy, Clara joined the
NSDAP (National Socialist German Worker’s Party; membership number 3610105) [22*]. His inaugural address in Leipzig,
attended by representatives of all NSDAP organisations and
held ‘‘not in tails, but in simple brownshirt’’ [23], was a
political demonstration rather than an academic ceremony. His
speech, published in a well-known general medical journal,
explicitly welcomed the ‘‘National Socialist revolution of 1933’’
and urged scientists to ‘‘join the marching columns of our
Führer’’ [10].
FIGURE 2.
Max Clara (1899–1966).
EUROPEAN RESPIRATORY JOURNAL
From 1936 to 1942, Clara actively participated in the
Nationalsozialistischer Deutscher Dozentenbund (National Socialist
German League of Lecturers). He was the League’s branch head
(Dozentenbundsführer) for Leipzig University, and also Acting
District Head (kommissarischer Gaudozentenführer) of Saxony from
late 1941. To our knowledge, Clara never joined any other
NSDAP suborganisations, such as the SA or the SS. The
organisation Dozentenbund was founded in 1935 to represent
NSDAP interests within academia and to foster the development
of National Socialist science [24]. While the content of Clara’s
scientific publications was not political and did not contribute to
a racist or anti-Semitic ‘‘pseudoscience’’, he actively participated
in university politics, which included providing politically
biased appraisals for scholarships, intimidating dissenting
colleagues [25] and influencing appointment procedures. For
example, in 1937, Clara’s appraisal prevented the appointment
of Gerhard Gesemann from Prague (Czechoslovakia) to the
VOLUME 36 NUMBER 4
723
c
HISTORICAL PERSPECTIVE
A. WINKELMANN AND T. NOACK
newly founded position of Chair for Slavonic Studies in Leipzig;
Clara’s 16-page expert assessment accused Gesemann of
collaboration with Jewish professors, thus going ‘‘against the
concept of the Nordic Race’’ [19, 26*].
In another appointment process, for the Chair of Otorhinolaryngology in Leipzig, Clara favoured a different candidate
to that of the local NSDAP Gauleiter (district leader). The
subsequent quarrel with the powerful and autocratic Gauleiter
resulted in an official reprimand of Clara by the Supreme Party
Court in September 1942, a ruling mitigated but upheld in an
appeal hearing in February 1943 [27*]. We do not know
whether this ruling had any consequences for Clara.
As Gaudozentenführer, Clara wrote an introduction to a national
academic directory of 1942, in which he stated ‘‘with pride that
science has contributed to the great plans of the Führer’’ and
called for scientists to submit to the reigning ideology and to be
ready to secure the German claim to European leadership
‘‘intellectually as much as by the politics of force’’ [11]. Clara
also agitated for the NSDAP in the Anatomische Gesellschaft, the
society of German-speaking anatomists. In 1939, he and the
outspoken National Socialist Eduard Pernkopf formed half of
the four-member executive committee [28]. The Viennese
anatomist Pernkopf is well-known for his anatomical atlas,
which has recently been proven to be based, at least in part, on
specimens from executed Nazi victims [29]. Clara’s and
Pernkopf’s attempts to transform the Anatomische Gesellschaft
into a National Socialist organisation met with resistance and
had limited success [30], and Clara’s name does not appear in
its membership lists after the post-war re-establishment of the
society in 1949. This, as much as his futile search for a post
after 1946, demonstrates that Clara’s career, so closely allied
with the NSDAP, saw him ostracised in German post-war
academia.
The controversial post-war denazification process [31, 32]
classified Clara as a Mitläufer (follower) in June 1947, but
cleared him upon appeal the following year [33*]. Clara had
successfully argued that his quarrel with the Gauleiter had been
an act of ‘‘active resistance’’ against party leaders, which had
eventually led, against his wishes, to his posting to the Chair of
Anatomy in Munich in late 1942. This version of the facts is,
however, unlikely. First, his remuneration package in Munich
was much more handsome than that in Leipzig [14*]. Secondly,
archived letters from the Ministry of Education demonstrate
that Clara actively strived for this post from at least 1941 [18*,
20*]. Therefore, his posting could also be interpreted as an
effective promotion and his alleged ‘‘active resistance’’ against
the Gauleiter as a power struggle within NSDAP. But, the
Denazification Tribunal did not refer to the mentioned sources
and by that time, acquittals by such tribunals were already
very common [31].
It should, however, also be noted that the denazification
records include additional affidavits describing Clara’s support for a ‘‘half-Jewish’’ doctoral candidate prior to 1938 and
for fellow anatomist Titus von Lanz, who was prosecuted by
the Nazis for having a Jewish wife [34*]. Nevertheless, von
Lanz later joined his colleagues’ efforts to prevent Clara from
returning to his post at the Anatomy Dept of Munich
University [18*].
724
VOLUME 36 NUMBER 4
Clara’s ‘‘material’’ and the Clara cell
In 1937, Clara described a new cell type in the terminal
bronchioli, which he characterised morphologically as having
secretory granules and a dome-shaped apical surface without
cilia (see fig. 1 of the online supplementary material) [1]. Clara
described the material as ‘‘stemming exclusively from executed individuals, who were preserved by vascular injection
immediately after death’’ [1] and added that he assumed this
‘‘rather extensive and perfectly fixed material’’ had given him
an advantage over previous researchers. Of Clara’s 25
publications between 1935 and 1945 [12], nine were based on
tissue from executed prisoners. At least 14 papers published by
co-workers at his Leipzig institute were also based on such
tissue.
The extensive use of bodies of executed prisoners for
anatomical purposes was based on the rising number of
executions during the Nazi era. However, the bodies of
executed prisoners had been used prior to the Nazi regime,
and the practice was sanctioned by laws passed as early as
1877. These laws remained in place during the 1930s, with the
Nazi authorities merely passing decrees in 1933 and 1939 that
regulated the distribution of bodies from specific centralised
execution sites to individual anatomical departments throughout the country [30, 35, 36]. Clara’s institute in Leipzig was
regularly allocated bodies from executions in nearby Dresden,
where more than 1,300 prisoners were put to death between
1933 and 1945, most for political reasons. Specifically in
Dresden, many prisoners had been resistance fighters from
Bohemia and Moravia, captured after the German occupation
in 1938, and Poland, after its defeat in 1939 [37, 38]. However,
we have been unable to link the names of specific executed
prisoners to any of Clara’s publications to date.
Clara was not simply a passive recipient of the bodies. Only a
week after assuming his post as Director of the Anatomical
Institute in Leipzig, he wrote to the Saxon State Ministry of
Education urging it to extend laws permitting the use of bodies
of executed prisoners. As the law of 1877 still precluded
anatomical dissection if the relatives requested the body, Clara
now suggested changing the law to allow anatomical dissection regardless of the family’s wishes [39*]. He also suggested
that, until the law was changed, researchers should dissect
such bodies regardless of whether they had appropriate
authorisation, but camouflage their illegal actions by preserving the external appearance of the bodies, a suggestion
supported by the Chief Prosecutor of Dresden [40*].
In March 1936, the Ministry finally consented to dissection
even if relatives had requested the bodies, but forbade any
removal of organs [41*]. This effectively prohibited Clara’s
histological research if the bodies were indeed claimed by the
families, but, given Clara’s documented objections, we do not
know whether he adhered to the decision. A formal decree
stipulating that the families no longer be informed of the
execution was only issued in 1942 [36]. As this regulation led to
desperate relatives approaching the anatomical institutes in
search of the remains of their loved ones, Clara later suggested
to the local prison administration in Munich that the
anatomical use of the bodies should not be disclosed at all to
the relatives [42*].
EUROPEAN RESPIRATORY JOURNAL
A. WINKELMANN AND T. NOACK
Source texts also indicate that Clara [43] and his co-workers
[44, 45] experimented on at least one of the prisoners sentenced
to execution. To investigate the effect of oral vitamin C uptake
on the histochemical localisation of ascorbic acid in cerebral
cells, the male was administered vitamin C tablets for 5 days
prior to his death [43–45]. It is implausible that a prisoner
awaiting his execution would be given vitamin C for other
reasons than as part of an experiment.
The establishment of the ‘‘Clara cell’’ as eponym
As for the post-war establishment of the term ‘‘Clara cell’’ in
medical terminology, it seems that the first authors to quote
Clara’s original description were ANDREW and BURNS [46] in
1947. The British authors stated that the cells were ‘‘described
first by Clara in male and rabbit’’ and were investigated ‘‘in
material from executed individuals’’; however, they did not
refer to the cells by the eponym. To our knowledge, the first to
use the eponym, in its French version ‘‘cellule de Clara’’, was
POLICARD et al. [2] in 1955 in an ultrastructural description of
the bronchioli of the rat. It seems that the eponym was then
promoted, at least in Germany, by Erich Schiller, a pupil of
Clara [47]. None of these publications or others from that
period which quote Clara’s paper [48, 49] contain any
indication of a critical stance towards Clara himself or the
source of his research material. And while his former
colleagues from Munich, in their statement of 1948 (see
previous, and [18*]) were very critical of Clara’s National
Socialist engagement, they did not mention his research either.
Moreover, Clara himself continued to use the specimens in the
post-war period. Even 7 years after the Nazi era, in a
publication again based on histological specimens from the
war years, his identification of the source of his specimens was
limited to the statement: ‘‘healthy individuals, who died a
sudden death after variable duration of imprisonment’’ [50].
DISCUSSION
We have shown that Max Clara was an active and outspoken
Nazi. His support of the Nazi system is clearly documented
over many years, at least from 1935 to 1942 [10, 11]. As we have
shown, his eventual acquittal by the post-war Denazification
Tribunal was erroneous, as some relevant evidence was not
considered. Clara’s post-war claim to ‘‘active resistance’’
certainly belittles the efforts of true resistance activists.
His original description of the Clara cell in 1937 was based on
tissue from executed prisoners. Using the bodies of executed
prisoners for research purposes was neither illegal at the time
(as long as the relatives did not request the body) nor a practice
limited to the Nazi regime [51, 52]. However, the growing
terrorist aspect of jurisdiction was specific to the Third Reich. It
led to an enormous rise in executions, from 1–4 per year before
1933 to about 100 per year after 1933 and to more than 4,000
executions in 1943 [53]. These numbers do not include military
executions, murder by the Gestapo and deaths in concentration
and extermination camps.
German and Austrian anatomists benefited from these changes
through an unprecedented cadaver supply mainly used for
teaching purposes, but also for research [52, 54–56]. By making
use of the cadavers, they, willingly or not, colluded with a
political strategy that sought to eliminate not just dissidence,
but also eliminated the very memory of the dissidence, in so
EUROPEAN RESPIRATORY JOURNAL
HISTORICAL PERSPECTIVE
far as the executed were denied proper burial [35]. This has
been described as ‘‘moral complicity’’ with the system [57]. As
we have shown, Clara …
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