He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror. To examine the ethical issues involved, the author first reviews recently published work regarding Pernkopf and his atlas, with the caution that facts are few in a debate where emotions run high and opinions abound. He then considers what has been written by bioethicists on the use of scientific data from the Nazi era and how those arguments might apply to Pernkopf and his atlas. Important questions remain, however. For example, are scientific data tainted by their associations with Nazism, or should such data including the atlas be assessed on their own merits, separate from the persons and ideologies involved in their creation?
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Conflicts can occur between the principle of freedom of information treasured by librarians and ethical standards of scientific research involving the propriety of using data derived from immoral or dishonorable experimentation. A prime example of this conflict was brought to the attention of the medical and library communities in when articles claiming that the subjects of the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust.
While few have disputed the accuracy, artistic, or educational value of the Pernkopf atlas, some have argued that the use of such subjects violates standards of medical ethics involving inhuman and degrading treatment of subjects or disrespect of a human corpse.
Efforts were made to remove the book from medical libraries. In this article, the history of the Pernkopf atlas and the controversy surrounding it are reviewed. The results of a survey of academic medical libraries concerning their treatment of the Pernkopf atlas are reported, and the ethical implications of these issues as they affect the responsibilities of librarians is discussed. The issues raised for medical librarians by the Pernkopf atlas bring to the fore the conflict between censorship, long held by librarians to be unethical, and the need to uphold the ethical standards of the medical and scientific communities in the handling of scientific data and material that may be tainted by its unethical origins.
In this case, the ethical questions concern the origin of the cadavers used for the dissections from which its anatomical illustrations are drawn. To begin to understand the ethical dilemma of the Pernkopf atlas, one must first consider the background of the physician whose work the atlas was. The life of Eduard Pernkopf was recounted by Williams [ 1 ]. Pernkopf was born on November 24, , in a small village in Lower Austria. He enrolled in the Vienna Medical School in , where he was active in a nationalistic German student fraternity.
Pernkopf received his medical degree in , served as a physician in the army for one year during World War I, and taught anatomy at various schools throughout Austria. While in medical school Pernkopf attracted the attention of the director of the Anatomy Institute of Vienna, then the most important such center.
He became assistant director in , associate professor of anatomy at the University of Vienna in , professor in , and director of the Anatomy Institute in April He joined the Storm Troopers, or Brown Shirts, a year later. He was an active and fervent party member. One month after Nazi Germany invaded Austria in , Pernkopf was made dean of the medical faculty in Vienna. From to , he was rektor magnificus president of the University of Vienna. At the time that Pernkopf was appointed dean of the medical faculty of the University of Vienna, the Wiener Klinische Wochenschrift was the official publication of the Viennese Society of Doctors.
Pernkopf's name appeared on the masthead of that journal for the first time in the May 20, , issue, just several weeks after annexation, when the supporting organization, the Vienna Society of Doctors, was dissolved by the Nazis [ 2 ].
Pernkopf, dean. Pernkopf's first issue included his plans for his journal. He and his new editors began by swearing undying allegiance to the new Reich and promising that the journal would serve the fatherland [ 3 ].
He said that the idea of National Socialism must permeate education and science and that freedom in the liberal sense leads to chaos, which could not be permitted in science [ 4 ]. He told the faculty and students that the only useful goal of art and science was service to the nation, that National Socialism was devoted to the practical solution of problems, and that the critical issues that anatomy and embryology could address were constitution and race.
The dean promised that all disciplines in the medical faculty would work on the problem of race. The curriculum would change to include race physiology, race psychology, and race pathology [ 5 ].
Another of Pernkopf's first acts as dean of the faculty was to enforce the Nazi order to cleanse the University of Vienna of Jews and other unwanted individuals. All professors were required to swear an oath of loyalty to Hitler, but only politically desirable persons or those entitled to do so under the Nuremberg Race Laws were allowed to take the oath [ 6 ].
Within weeks, the university had removed all Jews and other opponents of Nazism; of the members of the faculty of medicine were dismissed. He was, however, held in an Allied prison camp near Salzburg for three years. He returned to Vienna where his Anatomy Institute had been largely destroyed by Allied bombing.
He was stripped of all titles and appointments, but was allowed to continue work on his atlas in the Neurological Institute. Pernkopf died suddenly of a stroke on April 17, So what was this atlas the Nazi anatomist Eduard Pernkopf was involved in? Pernkopf's Topographical Anatomy of Man is generally considered by anatomists and surgeons to be a unique classic among anatomy atlases.
Its classic status and significant contribution to the health professions remains unchallenged. It is well known that some of the artists who painted the illustrations for the Pernkopf atlas were themselves active and loyal members of the National Socialist Party in Austria. Erich Lepier, Franze Batke, and Karl Endtresser demonstrated their allegiance to Nazi ideology by signing their anatomic paintings with Nazi icons.
Lepier often signed his paintings with a swastika edition, volume 2, Figure , tafel 94, opposite page While the illustrations themselves do not provide any direct evidence concerning the origins of the subjects, small details in some illustrations raised suspicions [ 9 ]. The wasted appearance and crudely shaven head of a young man in an illustration of a dissection by Lepier suggested that the subject might have been a wartime prisoner edition, volume 3, Figure 50, tafel 43, opposite page A Batke illustration edition, volume 3, Figure 9, tafels 3 and 4, opposite page 44 showed a cadaver with very short hair; cadavers used in anatomy books usually had completely shaved heads.
Endtresser painted a dissection of the femoral region of a male who appears to have been circumcised edition, volume 2, Figure , tafel , opposite page Lepier's painting of an infant with the umbilical cord still attached edition, volume 2, Figure 6, opposite page 39 led to the questioning of the origins and cause of death of the subjects. A article in the Annals of Internal Medicine, recounted the history of the University of Vienna in [ 10 ]. It detailed Pernkopf's administrative and political activities and described his professional work on the publication of an anatomic atlas.
The atlas was said to contain material from children killed in a Viennese hospital and that Pernkopf's Institute of Anatomy used the corpses of executed persons for teaching purposes. The piece that really sparked the current controversy about the Pernkopf atlas was a letter to the editor of JAMA in November signed by a professor of dental surgery from Columbia University and a professor of family and community medicine from the University of Toronto [ 11 ]. Most pointedly they said that.
The precise origins of the cadavers used in Pernkopf's work are unknown, but evidence suggests they may have been victims of political terror. It is known that the Anatomy Institute of the University of Vienna received the cadavers of prisoners executed at the Vienna District Court and of others put to death at Gestapo execution chambers in Linz, Munich, and Prague. Their letter called the Pernkopf atlas a legacy of the tragic era when abuses of medicine pervaded the entire medical profession.
In March , the Israel Holocaust and Martyrs Remembrance authority, Yad Vashem, asked the rector of the University of Vienna and the publisher of the atlas to make an official investigation to determine who the subjects of the Pernkopf atlas were and how they died; if the subjects were, or could have been, victims of the Nazis, to establish a public commemoration of the victims; and to continue to publish the atlas with an acknowledgment documenting the history of Pernkopf and commemorating the victims [ 12, 13 ].
The letter indicated that preliminary investigations suggested that, during the Nazi dictatorship, the anatomy department routinely received the corpses of executed persons, among whom reportedly were renowned dissidents; that brain preparations derived from children under the euthanasia program in the Psychiatrishes Krankenhaus Bauingartner Hohe in Vienna which was never an integral part of the university were still stored there, but would soon be properly interred; and that the Universities of Graz and Prague were supplied with corpses of prisoners interned at the Mauthausen concentration camp, but the fate of these corpses was unclear.
The commission stated that there was no doubt that the Viennese school of anatomy used the bodies of Nazi victims for scientific purposes and concluded that it must be assumed with considerable certainty that Pernkopf used these preparations to illustrate his atlas.
It was, however, at that time impossible either to prove this conclusively or conclusively identify the subjects and whether they included Jewish victims. Currently, it cannot be excluded that certain preparations used for the illustrations in this atlas were obtained from political victims of the National Socialist regime.
Furthermore, it is unclear whether cadavers were at that time supplied to the Institute of Anatomy at the University of Vienna not only from the Vienna district court but also from concentration camps. Pending the results of the investigation, it is therefore within the individual user's ethical responsibility to decide whether and in which way he wishes to use this book.
The final report of the commission at the University of Vienna was issued October 1, [ 17 ]. The investigation revealed that the Institute of Anatomy received at least. In these cases, however, the investigation was able neither to prove nor to disprove the suspicions. Because of the systematic practice of making specimens anonymous, it seems likely that a final clarification of such suspicions will not now be possible. So what do we do with material with this kind of history?
Much of the previous debate on the use of Nazi scientific data focused on the hypothermia experiments carried out on concentration camp inmates at Dachau. That debate was rendered moot when analysis revealed the results to be based on experiments with serious errors in experimental design, data collection, and analysis [ 19 ]. In , the Environmental Protection Agency ordered that Nazi data on human exposure to phosgene gas be excluded from a study the agency had commissioned [ 20 ].
However, the validity of the Pernkopf data has never been challenged, only lauded. Many arguments can be raised against the use of material like the Pernkopf atlas.
For example, Abraham Foxman, national director of the Anti-Defamation League, said that the research findings of heinous crimes or atrocities should not be used, even if it would do good, because it would retrospectively cleanse the atrocity and possibly justify similar acts in the future [ 22 ].
Freedman has thoroughly analyzed many of these issues [ 23 ], and Riggs has provided a readable summary of Freedman's reasoning [ 24 ].
The current author, Riggs, Greene, and others believe that the active use of the atlas itself is the most fitting tribute to those who died for it. It is ironic retribution for the Jewish cadavers or whoever died for whatever their beliefs used to illustrate a Nazi's anatomic atlas to be immortalized by it.
Using this atlas allows these cadavers to speak to us from half a century ago. They make us reexamine and again repudiate the Nazi beliefs that created a society that killed them [ 25, 26 ]. Howard Spiro, at the Program for Humanities in Medicine at Yale University, says it does not matter where the victims came from—they were all humans, and all were murdered.
Waverly conducted their own inquiry, speaking to authors and illustrators who worked on the atlas after Pernkopf died in , reading letters from present faculty at the University of Vienna, and talking with a student who attended the medical school during the war [ 28 ].
Edward B. Hutton, Jr. In a November letter to JAMA, Hutton said his company continued to publish the Pernkopf atlas because of its scientific merit and because, to date, no concrete evidence had been found to substantiate Pernkopf's use of cadavers originating from Nazi concentration camp victims [ 29 ].
Others argue that the publisher's suggestion that the scientific work of the author be considered separately from his beliefs is impossible, that a work cannot be separated from its creator [ 30 ]. Still others think that what is created does not change when one learns about the creator. Malcolm Hast, of Northwestern University Medical School, who reviewed the book for JAMA, said that as it was one of the most beautiful anatomy books published, the book should continue to be used.
He believed that if something was good, it could not be thrown away any more than the knowledge already gained from it could be expurgated from readers' minds [ 32 ]. Ernest April, an anatomist at Columbia University's College of Physicians and Surgeons, believed that one could not detract from the fact that the book was phenomenal, complete, thorough, and authoritative despite the knowledge that Pernkopf was not a good person and belonged to the wrong party [ 34 ].
Howard Israel, M. Israel noted that there was no indication to the unsuspecting user that the book had any link to Nazi medicine, and he viewed suppression of the work as inappropriate and reminiscent of the book burnings that took place in Nazi Germany. In the end, all potential users of the Pernkopf atlas must make their own personal decisions as to how to deal with information and data obtained from Nazi medicine.
Questions about the fate of the individual works of each of Pernkopf's Nazi artists have been raised. Must then each individual piece of their work be repudiated and tracked down and its removal from all currently available publications demanded? While an admirable idea, this practice would be extremely difficult for libraries and owners of private subscriptions to do. Libraries already have difficulty handling official errata and retractions [ 37—39 ]. This author agrees with Spiro that to forbid the publication of the Pernkopf atlas would too much resemble the Nazi book burnings [ 40 ].
Spiro does not want the Nazi icons removed, because that would make history untrue. The icons on the pages of Pernkopf's atlas remind doctors of the hell that people much like themselves created. Spiro hopes that such reminders keep physicians from ever again abetting such evil.
Not to publish the Pernkopf atlas also infringes on free speech and freedom of the press.
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. This classic among atlases of anatomy is derived from Eduard Pernkopf's seven-volume textbook, Topographische Anatomie des Menschen. The majority of the illustrations in this atlas are truly works of art, demonstrating by their clarity and precision the best in collaboration between master medical artists and skillful anatomic prosectors.
What Should We Do About Eduard Pernkopf's Atlas?
Eduard Pernkopf November 24, — April 17, was an Austrian professor of anatomy who later served as rector of the University of Vienna , his alma mater. He is best known for his seven-volume anatomical atlas, Topographische Anatomie des Menschen translated as Atlas of Topographical and Applied Human Anatomy ; often colloquially known as the Pernkopf atlas or just Pernkopf , prepared by Pernkopf and four artists over a year period. Pernkopf was born in in the Lower Austria village of Rappottenstein , near the border with Bavaria. The youngest of three sons, he seemed to be considering a career in music upon his completion of the Gymnasium in Horn. However, the death of his father, the village's doctor, in led him to pursue medicine instead, as his father's death caused the family considerable hardship that a career as a physician was more likely to reverse.
Nazi Origins of an Anatomy Text: The Pernkopf Atlas
To the Editor. One legacy of that tragic era endures today through the continued publication of a critically acclaimed atlas, Pernkopf Anatomy , 1 named after the anatomist Professor Eduard Pernkopf of the University of Vienna. The original Pernkopf work contains more than detailed paintings of dissections. Recent editions include paintings from the earlier volumes with most of the Nazi icons eliminated.
Eduard Pernkopf: The Nazi book of anatomy still used by surgeons