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Nitsche received his medical license in 1901 and a professorship in 1925. Nitsche did not join the Nazi Party until May 1933, and he was driven not so much by Nazi racial ideology as by his own support of racial science and his vision of "progressive medicine". Being well established, Nitsche was no longer motivated by the prospect of career advancement but was rather ideologically committed when he later joined Action T4.
He was deputy director of the Sonnenstein Clinic from 1913 to 1918 and director of the institution 1928 to 1939. In 1940 he became deputy director of department T4 under Werner Heyde, and his successor as director from the end of 1941.