Genocide commenced as word and action in the Twentieth Century. The most scrutinized example has been that of Nazi Germany during the Holocaust. There are compelling reasons to propose this paradigm. First, there is a plethora of historical information regarding the events in question as well as their precursors. The magnitude of those dying at the hands of the perpetrators continues to stun, even after a Century distinguished by murder on a horrific scale. Finally, the international justice that followed at Nuremberg elaborated upon the concept of “crimes against humanity.” To add to the horror, at every stage of the evil called Holocaust, physicians killed as if their consciences had been seared. Unfortunately, other notorious examples of active physician participation in genocide have neither been critiqued nor punished appropriately. Genocide, including that variety prospered by physicians, was developed prior to the Holocaust, and mimicked later. Two prominent examples must not be forgotten. The Ottoman Empire sponsored the slaughter of Armenians before and during World War I. Active participation by Turkish physicians was documented, and remains unpunished. These physicians were predecessors to the legacy of Nazi Doctors. In fact, they inhabited the 20th Century’s first “culture of death,” one nurtured by nationalism to the exclusion of Hippocratism. Also, parallels between the Turkish and Nazi experiences suggest that rather than coincidence, complicity and modeling by both parties catalyzed killing. The outcome was homicide on an unprecedented scale during both World Wars. In the 1930s, a second, distinct group thrived and also preceded the Nazis. Japanese physicians of that era perpetrated heinous crimes on the Manchurians and Chinese under the guise of nationalism and medical progress. The evolution of germ warfare in their hands can be called nothing less than satanic. For these two occurrences, humankind was not prepared to judge and actually ignored the crimes under the guise of political expedience. The absence of retributive justice empowered evil nations as well as physicians to perpetrate mass murder later. The United States of America not only passively avoided a confrontation with justice, but also actively suppressed the efforts of others. The Ottoman Turkish and Japanese physicians set the stage for the Holocaust as well as other “killing fields” that followed. American participation was conspicuously negative.