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In his book Mein Kampf (1924), Hitler wrote that one day racial hygiene, "will appear as a deed greater than the most victorious wars of our present bourgeois era".The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary "antisocial" behaviour was widely accepted.The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugene Bleuler, who presumed racial deterioration because of mental and physical cripples in his Textbook of Psychiatry: 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.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 Hellmuth Unger, a consultant for "child euthanasia".The killings took place from September 1939 to August 1941, during which 70,273 people were recorded as being killed at various extermination centres located at psychiatric hospitals in Germany and Austria, along with those in occupied Poland.

Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation.

On the other hand, in the summer of 1941, protests were led in Germany by Bishop von Galen, whose intervention, according to Richard J.

Evans, led to "the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich." Technology that was developed under Aktion T4, particularly the use of lethal gas to commit mass murder, was taken over by the medical division of the Reich Interior Ministry, along with personnel who had participated in the development of the technology and later participated in Operation Reinhard.

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. Read '[A] New People', the monthly magazine of the Bureau for Race Politics of the NSDAP." The T4 programme stemmed from the Nazi Party policy of "racial hygiene", a belief that the German people needed to be cleansed of racial enemies, which included people with disabilities as well as anyone who was confined to a mental health facility.

The euthanasia programme was part of the evolution of the policy of administrative murder that culminated in the extermination of Jews of Europe during the Nazi genocides.

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