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This book is among the most important recently published about Germany and the Second World War. Its subject is the euthanasia programme under which as many as 200,000 Germans were murdered by their fellow countrymen. Their crime in the eyes of the Nazi ideologues was that they were mentally ill or physically disabled.

Michael Burleigh has tackled with the very highest standards of scholarship a subject so distasteful that, like the Holocaust which followed it, the mind is by turns bewildered and distressed. His book is a quarry of evidence, found and assembled with considerable skill, in which he shows how the euthanasia killings reflected a non-medical agenda. One aim was central to the Nazi ideology: the so-called "purification" of the race. The other was styled as practical: to save money and resources for the Reich, and to create space in the institutions that cared for the mentally ill so that civilian and military battle casualties could have the use of them.

After the war the Americans found, at one of the main euthanasia centres, a careful calculation that had been made by the functionaries there as to the monetary savings which this mass murder had achieved for the Third Reich. Given the cost of maintaining each mental patient in that particular institution, and assuming a life expectancy of ten years per patient, the practitioners of euthanasia calculated a saving of almost a billion Reichsmarks. The official who had prepared this calculation noted: "This sum will have been, or has already been, saved by 1 September 1951 by reason of the disinfection of 70,3 persons which has been carried out to date."

Burleigh shows that the number of people who courageously protested, among them the Roman Catholic Bishop of Munster, Bishop Galen, was very small. Ironically, by the time of Galen's public protest in August 1941, the main euthanasia killing programme had been halted, having slightly exceeded its target of killing one chronic patient per thousand inhabitants of Germany, a horrendous statistic. But, on Hitler's express instructions, the euthanasia of children continued and, when the personnel involved in the adult killings were released from their task, these same experts took part in the first killing of Jews by gas, in specially designed vans sent to the Baltic.

Other euthanasia functionaries were transferred to one of the first death camps for Polish Jews, located in the remote village of Sobibor. Just as their work against Germans had taken place in isolated sanatoria, so much of their new work was deliberately hidden in obscure regions. One of those who had participated in the work of five separate euthanasia centres before 1941, Christian Wirth, was made the commandant of the death camp at Belzec, where 600,000 Jews were killed by gas. He was later assassinated by partisans while stationed in Trieste, the site of yet another killing centre, Santa Sabba, where several thousand Italian Jews and partisans were murdered.

Even the Berlin headquarters of the euthanasia action, in a villa in Charlottenberg, was not, Burleigh writes, as remote from the killing as might give it a moral distinction. All the Berlin employees of the programme "could avail themselves of cut price dental work, which utilised gold recycled from the mouths of the victims". It was university professors who recommended students who might have an aptitude for the work in hand.

Bureaucratic methods were employed to speed the killing: Burleigh publishes the work schedule of Hermann Pfanmuller, who could referee 300 forms in a day: that is, condemn 300 mentally ill people to death between breakfast and supper (he liked to have his desk clear at night). Writing to his wife after the war, Pfanmuller confided that he "was always assiduous, correct, never sloppy, well known and recognised as being capable and objective, careful and exact; I worked for others without thought of gain, solely in the interests of the patients in my care". Payment was made by piecework, thus 300 Reichsmarks for 3,500 forms a month. Pfanmuller received a five-year prison sentence. His wife was indignant. It was "humane", she wrote, when German refugees had to live outside in the cold and thousands were freezing, "but it's a crime against the state when someone like you put to sleep the sort of lumps of flesh that you had there in the asylum".

The origins of these crude and criminal euthanasia killings lay in pre-Hitler scientific tracts and theories. Burleigh prints a charming photograph of Alfred Hoche, co-author of Permission for the Destruction of Life Unworthy of Life on his bicycle in the 1920s. But most of those who carried out the mass murder of those Germans who were labelled as "mental defectives" during the Hitler years were not men of science or theory. The euthanasia programme, Burleigh writes, "represented a modest form of social mobility, whereby butchers, cooks, policemen or tram-ticket collectors could, and did, become camp commandants". They were "brutal and insensitive" before they started their euthanasia work, "tough and hard-drinking working-class males, who could have a party around a corpse or weep drunkenly as they sang plangent songs about their homeland around the barrack stove in the extermination camps". Two years before Jews were being deported to their deaths, Germans with severe mental or physical disabilities were being taken from hospitals to gas chambers.

The euthanasia killings of Germans by Germans were, like the mass murder of Jews, the subject of many postwar trials. As late as 1987 one such trial found two Germans guilty of having been the accessories to the murder respectively of 11,000 and 4,500 people in mental institutions. They received four-year prison sentences which, Burleigh points out, were one year more than the statutory minimum sentence for the same offence involving one victim. Yet in 1988 a Federal court of appeal decided that as both men must have taken holidays and leave while working in extermination centres, the number of victims for which they were personally responsible must have been "only" 9,200 and 2,340 respectively, whereupon their sentences were cut to three years.

This book is a major contribution to our historical knowledge, and to some of the most disturbing vagaries of the human mind and the misuse of authority: the perfection of the art of destroying ethical codes; the destruction and perversion of moralities which had been evolved over many centuries; and the relegation of whole groups of people to death without hesitation or remorse.

Martin Gilbert's book, The Holocaust, the Jewish Tragedy, is published by HarperCollins. His Atlas of the Holocaust (which includes a map of the pre-Holocaust euthanasia centres) is published by Routledge.