“Light, Air, and Sun!” Die englische Krankheit [The English Disease] and Health Education Films in the Third Reich

By Anja Laukötter (History of Emotions Dept., Max-Planck-Institute for Human Development, Berlin)

A darkly-lit parade of twisted, deformed people slowly, painfully, marches back and forth over a map of England, as the movie soundtrack sounds anxious notes of alarm. That extravagantly excessive scene introduces the Die englische Krankheit (The English Disease), a 13-minute black-and-white health education film on rickets, produced during wartime, under the supervision of Nazi authorities, by Universal Film AG (“UFA”), the largest German film studio of the time.^[1] After a censorship board approved it as suitable for adults and children, it premiered in Berlin in April of 1941.

Health education films had then for decades been made and shown in Germany. Shortly after its founding in 1917–18, UFA had set up a special “Cultural Division” to produce “cultural films” on a variety of educational topics.^[2] The Cultural Division was started up by Nicholas Kaufmann and Curt Thomalla. Kaufmann directed it and produced many films, along with well-known film industry contemporaries such as Ulrich K.T. Schulz, Wolfram Junghans, Martin Rikkli, and Wilhelm Prager. Between 1918 and 1933, the studio made movies on everything from natural history to zoology, adventure, and dance. The head of the Cultural Division, Nicholas Kaufmann, launched his career, early in the Weimar period, as a producer-director with films that focused on venereal disease, smallpox, and tuberculosis, work that inaugurated the “health education film,” a genre that in Germany and elsewhere continues on to the present day. The umbrella term “health education film” refers to a variety of motion pictures centered on medicine and hygiene that were produced with the intention of reforming or reinforcing beliefs concerning health, disease, and risk. These films are hybrids that combine fictional or documentary narratives with scientific explanations of how diseases spread and can be cured or prevented. Addressed to a broadly conceived public, in the early and mid-20th century they were usually screened in cinemas before a main feature or in public spaces such as lecture halls the featured film. Their subject matter was often controversial—topics included birth control, prostitution, vaccination, and contagious diseases, for example—and they were often tainted by nationalist, eugenicist, and propagandistic rhetoric.

Produced under conditions of mass mobilization during the Second World War, The English Disease provides an insight into how the health education film genre, and motion pictures in general, fared under the Nazis. It begins with strident propaganda, pumped up with gloomy lighting, disturbing music, and a scene of horror, and ends with sunny scenes of happy children skiing in nature. But it also interweaves scenes about the diagnosis, treatment and prevention of disease. This essay analyzes The English Disease within two overlapping frames. The first explores the film in relation to the health education film genre and its formal elements, techniques of persuasion, and forms of visualization. Given that The English Disease not only explains how one can prevent rickets but also promotes specific remedies, the article highlights the close connection between this particular film and the promotional features of the pharmaceutical industry. The second frame deals with the meaning of rickets in the Nazi-era and how things changed after the outbreak of war, in the period going up through the year 1941.

Health education film producers usually hired and worked closely with physicians, who supplied medical expertise and script consultation. In the case of The English Disease, the physician was a woman, Betina Ewerbeck.^[3] The author of the well-received novel Angela Koldewy (1939),^[4] Ewerbeck, like contemporaries such as Gottfried Benn, Hellmuth Unger, Karl Aloys Schenziner, was both a physician and a successful writer.^[5] Angela Koldewy tells the story of a young woman physician fighting for occupational emancipation. Holistic medicine plays an important role: both scientific medicine and the “whole” human being, including social background, are shown to be crucial to diagnosis.^[6] The novel also represents, approvingly, the doctrines of “racial hygiene”: the main character heroically refuses to marry her beloved on account of his racial background.^[7]

Rudolf Perak, who scored the film, worked on several feature films during the Nazi period.^[8] Gerhard Müller, the director of photography and another old hand, worked on many short documentaries since the early Weimar period. Perak and Müller had previously worked together at least twice before, on Stored Sun Energy (1934) and Creeping Poison: Burden of Humanity (1936).^[9] Both films were produced jointly by UFA and the pharmaceutical firm Bayer to promote drugs such as Aspirin (then still a brand name), Atebrin (a new anti-malarial drug), Vigantol (a vitamin D preparation) and anti-syphilis remedies.^[10] Although neither film was especially propagandistic, the collaboration of the two men on a number of film productions during the Nazi period suggests that both belonged to a network of well-connected film professionals.

Kurt Stefan, the director of The English Disease, was perhaps the most prominent of those involved. His first film, Hot Flag (1935), a patriotic big-budget salute to the German navy, was seen widely.^[11] In 1939, Stefan collaborated on the propaganda feature The Fight for Greater Germany (1939).^[12] A year later, the UFA board asked him to direct a dental hygiene film, a project that culminated in Health is not an Accident (1940).^[13] The year after that, he began work on The English Disease.^[14] The members of The English Disease’s production team, then, had plenty of experience in a variety of cinematic forms (from advertising to agricultural films) and, more specifically, experience working with medical topics in this medium. They were not only well-established and well-connected professionals but had embarked upon their film careers during the Nazi period. The exact nature of their connections to the Nazi party and regime remains an open question, but the details of their careers strongly suggest that they had some affiliations.^[15]

The English Disease deals with rickets, a commonly recognized problem in the 1940’s. Rickets (riquets in French, Rachitis in German) was identified and named in the middle of the seventeenth century by two Englishmen, Daniel Whistler and Francis Glisson. Two centuries later, the disease was considered to be a children’s disease, caused by poor nutrition and poor air.^[16] The colloquial name “English disease” originally derived from the fact that it had been first identified by an Englishmen. In the late nineteenth century, the name took on a political resonance, was increasingly linked to the problems of industrial capitalist society. Dire living and working conditions, reduced exposure to sunlight, and polluted and stuffy air were believed to cause the disease.^[17] Industrial capitalism deformed children, especially the sons and daughters of impoverished working people. Rickets thus became the object of social critique and a theme of Lebensreform (“life-style [health] reform”).^[18] The treatment and prevention of rickets increasingly seemed to be one of the many responsibilities of the welfare state.

Around the end of the nineteenth century, the standard treatment for rickets consisted of sunlight and cod liver oil. These were later supplemented by ultraviolet radiation and irradiated milk. In 1927, two of the largest pharmaceutical companies, Merck and IG Farben, developed a vitamin D treatment in the form of Vigantol, a commercial product that came to dominate the German market for many decades.^[19] Vigantol was promoted in pamphlets and advertisements published in medical journals (fig. 10) as well as popular media. Meanwhile, Bayer and other pharmaceutical companies produced a number of promotional films featuring the product, such as Vigantol (1933) and the aforementioned Stored Sun Energy (1934).^[20] In the Nazi period, Vigantol was presented as not only a medicine but also a natural remedy.^[21] Even though the therapeutic use of the product was well-established, new concerns about an increased number of cases of rickets arose in the 1930s, an anxiety that the Nazi regime addressed with particular vigor after the outbreak of the Second World War.

Given the Third Reich’s ongoing war mobilization effort, it is hardly surprising that The English Disease opens with strong political statements. The film’s opening sequence shows a fluttering Union Jack and the title of the film (fig. 1). Over a silhouetted map of Great Britain, a male voice states that “England claims the sad honor for itself that rickets is more widespread there than anywhere else”.^[22] As the camera zooms in, a cross-fade shows a procession of people walking in line, left to right, right to left, and back to front, all suffering from rickets (fig. 2). Some require walking sticks; others are hunched; still others go half-naked, to better demonstrate their deformed bodies. “This illness”, the narrator continues, “was used in the First World War by England as a means of conducting warfare.”^[23] The accusation—that Britain is not only a diseased nation but practices biological warfare —uses the film’s opening moments to score Nazi war propaganda points at a time when the two powers were battling fiercely in the air over England and Germany and on the ground around the Mediterranean.^[24] This was not, however, the first German film to promote anti-British themes. The short documentary Gentlemen (1940–41), a film that was released with the support of the Deutsche Wochenschau GmbH dealt with the supposedly unethical behavior of Englishmen at war, also claimed the British used rickets as a weapon.^[25] The anti-British line was part of a broader state film policy. The Nazi regime financially underwrote domestic film productions—some entirely propagandistic, but others, like The English Disease, with incidental, opportunistic propaganda messages—while limiting the importation of foreign films, and embargoing British and American films in particular.

The next scenes of The English Disease intensify argument. With the sufferers of rickets still cross-faded across the screen, the camera zooms into a copy of a left-wing British journal, Foreign Affairs: A Journal of International Understanding, and picks out the following paragraph of an article:

We tried to make our enemies unwilling that their children should be born; we tried to bring about such a state of destitution that those children, if born at all, should be born dead; that if they were born living their parents should have nothing to wrap them in but paper and no milk to feed them with; that if they grew up they should be more or less deformed by rickets; and that if ever these poor little devils reached the school age they should be too physically starved to be able to avoid becoming mentally stunted as well.^[26]

With the paragraph still in the background, two sentences are highlighted and translated into German: “we tried to make our enemies unwilling that their children should be born . . . that if they grew up they should be more or less deformed by rickets; and that if ever these poor little devils reached the school age they should be too physically starved to be able to avoid becoming mentally stunted as well.”

The quotation as cited in Die englische Krankheit, 1941

The quotation as it originally appeared in Foreign Affairs: A Journal of International Understanding, September 1920

Those words are excerpted from “The Future of Blockades—Part II,” by W. Arnold Forster (uncredited), an article published in 1920.^[27] Forster discussed the history and consequences of blockades, arguing for international control by the League of Nations. A comparison of the paragraph shown in the film with the original article reveals a key omission (figs. 3 and 4). The original paragraph opens with the claim that “we tried, just as the Germans tried, to make our enemies . . .”

The omission of the phrase “just as the Germans tried,” presents the German people, and by extension the Nazi regime, as a purely victimized and peaceful Other. The second omission leaves out the context of the excerpted quote from the original article. While Forster admitted that blockades were deliberately utilized by the war’s participants to generate outbreaks of diseases such as rickets, he concluded by questioning the practice, arguing that “we have got to have the sympathy to understand what it meant to all those millions to see their children die, and what it felt like so to starve for year after year . . .”^[28] The quotation, as cited in the film, then, is deliberately misleading, aimed at fostering resentment against the British.

Having framed rickets in this manner, The English Disease shifts entirely in tone: the film turns to an explanation of the effects of the disease upon the body. In this part the presentation of the disease (explaining cause, symptoms, and preventive measures), techniques of persuasion used (from repetition to contrast), and various forms of visualization (drawings, animations, and so on) are similar to films made in the late Wilhelmine and Weimar periods.

The new section begins by showing how the disease is manifested in the deformed legs of children. A physician uses his finger to highlight the deformation of the lower leg of a young child. An X-ray then shows the disease’s effects on the body in greater detail. The technique of using different types of images to illustrate the same phenomenon is repeated: next we see footage of a deformed body part, this time a swollen arm, a doctor digitally highlighting the nature of the deformation, and then an X-ray of the part. The X-rays visualize the body’s interior, function as scientific evidence of the medical diagnosis, serve to persuade the viewer of the film’s (and professional medicine’s) scientific objectivity—a technique often used in European and American health films from their beginnings in the 1910s.^[29]

Throughout The English Disease, viewers are presented with “compare-and-contrast” visual arguments. Health education films often presented before-and-afters of health and sickness, advisable and inadvisable courses of action, or simply black-and-white footage contrasted with color.^[30] For example, film footage of a swollen arm is contrasted with an X-ray of a healthy arm (fig. 5). Later on, the “compare-and-contrast” is used to advise on how and how not to deal with the issue of a baby’s exposure to sunlight, as well as to underline the importance of vitamin D.^[31]

After showing off some manifestations of rickets, The English Disease demonstrates the causes and consequences of disease through illustrations of body parts (fig. 6) in which animated pictograms of minerals like chalk (a dark circle), phosphor (a white circle), and vitamin D (a white triangle) move around the screen, instructing audiences on the importance of the interplay of these minerals.^[32] This is linked to an image of the deformed back of a young boy practicing gymnastics in a natural setting as the narrator explains: “when bone growth is arrested, rickets can no longer be cured. The doctor can do more than attempt to relieve the pain.”^[33]

X-rays comparing a healthy arm (left) with a diseased arm (right)

How bones grow.

The camera then shifts its gaze to a young girl’s back, introducing the next section of the film: the consequences of the disease for women. The technique of contrast is once again deployed, this time through a comparison of a “normal female pelvis” and a deformed one (fig. 7). The silhouettes of the two pelvises are superimposed to emphasize the difference between the two and to introduce the topic of potential birth problems.

In the scenes that follow, both the symptoms of the disease—sweating at the back of the head, the softening of the skull—and the means of preventing them are identified visually. This is accompanied by an enumerated list, another technique often used in health education films—“first requirement: the infant must be breastfed by the mother for as long as possible!”^[34]—while the camera shows a woman breastfeeding her baby.^[35] As the narrator continues with the next point—“spending time outdoors is vital for infants and small children!”—a mother takes her baby out of a carriage and exposes it to the sunlight. Dangerous sun exposure (the whole, naked body) is contrasted with healthy exposure (the head is covered).^[36] In doing so the didactic character of the film becomes once again clear.

A bit of war rhetoric re-appears in the last third of the film. As the film summarizes prevention practices (“light, air, sun—these are how to make war on rickets!”), we see nurses with children dancing ring-around-the rosy in a garden. The camera pans from diseased young children lying in their beds to healthy young children happily playing in the fresh air and sunlight (fig. 8). The film goes on to instruct the viewer on the importance of nutrition in the prevention of disease. The film explains the value of vegetables and salad, showing how they must be prepared, and again uses an animated diagram and pictograms (the provitamin is represented by black circles and vitamin D by a white triangle) to illustrate how the interior of the body processes good and healthy food. This sequence uses modern professional medicine, represented by the nurses (as well as the pictograms, x-rays, and the health education film itself)—the ideas and icons of Lebensreform (“light, air, and sun”, as well as nutrition) , a political movement that had previously been a staple of progressive Weimar medicine—to claim a fusion of scientific and holistic medicine as a Nazi principle, medical science that helps return the Volk to a state of natural health.^[37]

Films from the pre-war Nazi era such as Stored Sun Energy (1933) or Robert Koch (1939) often made use of slogans like “light, air, and sun” to implicitly make political points.^[38] The English Disease marks a decisive break with this practice: produced in wartime, it explicitly depicts the Nazi regime as peaceful and ethical—its values embodied in the use of nature to cure disease as opposed to using disease as a weapon. It is in this way that Lebensreform (and holistic medicine) could be linked to the health and warfare politics of the Nazi regime for propaganda purposes.

The last scenes of the film move even further in this direction, outlining the measures taken by the regime to fight rickets: the preventive health institutions established by the Nazi system and the “natural” remedy, Vigantol (see figs. 8-9). The viewer is shown scenes of nature in autumn and children skiing, as the narrator explains that in winter exposure to sun is insufficient to prevent rickets. “For this reason, the Reich health authorities’ [disease] prevention measures must be implemented throughout Germany. Advisory sessions will be arranged for every mother and child, and every infant will undergo a detailed examination.”^[39] Nurses again appear, this time weighing and measuring infants; a physician meanwhile examines a baby. “In order to prevent the English disease, every mother in Greater Germany will receive vitamin D in the form of Vigantol.”^[40] Special techniques, including the use of sunlamps for infants and twins, are also presented. Finally, the film illustrates how mothers should allot and dispense medicines to children.^[41]

As discussed earlier, The English Disease composer Rudolf Perak and cameraman Gerhard Müller had both previously worked on films that centered on Vigantol.^[42] In these films the production process of the promoted pharmaceutical and its applications are highlighted. Visually, the films utilize close-up images of the pharmaceutical product or panning shots of the production process that underline the high scientific and technological standards. The films are a highly professionalized form of advertisement—as one can see in figure 10, a pamphlet on Vigantol from 1935 from the pharmaceutical giants Bayer and Merck.

The English Disease is different. It never directly shows Vigantol and the product’s name is only mentioned a few times in the narration. While we see its application when a mother is depicted adding Vigantol drops to baby food, the medicine bottle lacks a label (fig. 9). The re-use of filmed scenes or images from earlier films was commonplace at the time, and Stored Sun Energywould have been an obvious potential source for borrowing, but The English Disease only uses material generated for its own production. The absence of a visual sign specifically representing Vigantol as a remedy in The English Disease suggests that it is not so much the drug that cures but the concerted actions of a modern medical system with a holistic approach to the care of its people. Vigantol therefore becomes a natural remedy linked more to holistic medicine than to the pharmaceutical industry. The film is thus not an advertisement for a pharmaceutical product but an advertisement for a political system based on progressive institutions.

The film’s last triumphal scenes celebrate the institutionalized scientific knowledge of the modern medical professions (physicians and nurses in Mütterberatungsstellen or mothering advice centers), medical-industrial technology (such as sunlamps and Vigantol), and the determined activism of the Third Reich. We see happily applauding children (signifying approval of the film’s visual and spoken messages) and active young adults running into the sea to bathe, as the narrator, referring back to the opening propaganda section, declaims: “National Socialist Germany is making sure that the English disease will never again become a German disease.”^[43]

Disease is thus once again identified with foreign political systems while the Nazi regime is presented as a modern system committed to taking wide-ranging measures to ensure the health of its population.

To summarize: engaging in a close reading of the film The English Disease, this article has shown that the Nazi regime did not reinvent health education films altogether but rather merged continuities and differences within this visual culture into its own ideological and politicized format.^[44] In drawing on a structured presentation of the disease, techniques of persuasion, and a visual style developed in health education films from the Weimar Republic and the early Nazi era, the film utilizes established filmic conventions of public campaigning and transforms them to its own ends. The film thus mirrors visual and narrative structures that were already integrated into German film culture and familiar to German society.

This article has moreover attempted to demonstrate that the outbreak of the Second World War and mass mobilization led to an intensification of propagandistic rhetoric in films such as The English Disease. On the visual level, we can see that the film draws on imagery which explores the connection between bodily culture, health, and nature to underscore a new “modernism” that oscillates between Lebensreform, holistic medicine, social hygiene, traditional remedies, and industrial products such as Vigantol. At the same time, highly aestheticized images of the inner processes of the body drive this argument even further: the idealized healthy body becomes the subject of a political system. We can also read the narrative content of the film and its allusion to both early health education films and its framing of the political system (including the health system and war practices) of the Nazi regime in this vein. The film opens and ends with references to these systems, deploying words and images that link the “enemy of disease” with political enemies and the health of the German population with the “correct system”. In doing so, the film makes explicit that questions of disease and healthy bodies were not so much social as political issues. In this sense, the healthy body becomes nothing more than a political instrument of the Nazi system.

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