Tobar So what do we do with material with this kind of history? New Engl J Med. They make us reexamine and again repudiate the Nazi beliefs that created a society that killed pernkopf anatomy [ 25, 26 ]. The investigation revealed that the Institute of Anatomy received at least. The Pernkopf Anatomy Atlas: In subsequent editions all but two of the Nazi insignia and swastika have been carefully airbrushed out in later editions when Nazi connections were no longer appreciated Seidelman.

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Abstract 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. 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.

INTRODUCTION 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.

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, dean. 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 ].

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, 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 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 ].

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.

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. The investigation revealed that the Institute of Anatomy received at least 1, bodies of executed persons, including 8 victims of Jewish origin.

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. 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 ]. 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. 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. 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. 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. 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. 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.

But the executive editor of the New England Journal of Medicine says many editors do not invoke this principle, and many others are not even aware of it [ 42 ]. Many are reluctant to reject work they believe is unethical as long as the violations are not excessive or flagrant. They are reluctant to accept responsibility for evaluating the ethics of a study, assuming that evaluation was done at the institution where the work was done.

Editors are also influenced by the importance of the results; a study that has great practical significance is difficult to reject. Editors and reviewers have been more willing to forgive ethical lapses than to forgive scientific lapses. The group has become increasingly influential over the years in developing common policies for the more than journals that currently adhere to their standards. In , the group revised its standards on ethics in clinical research to include a statement on the protection of patient rights to privacy without informed consent [ 43 ].

All individuals involved in the research process at each step along the way have the obligation to evaluate the ethical content of the work, just as they evaluate the scientific content. This group includes the investigators, institutional review boards, funding agencies, reviewers, and editors.

A physician at St. In Great Britain, the Royal College of Surgeons confirmed that it had a copy of the book but would not comment on whether it would be removed as a result of an inquiry.

The libraries associated with the members of the American Association of Medical Colleges were surveyed; sixty responded. Almost all responding institutions held at least one edition of the Pernkopf atlas. Of the respondents, five libraries had been questioned about the atlas by faculty, students, or library users. In nine libraries, library faculty and staff brought up the issue.

Only one library withdrew the book. Several moved it to their special or historical collections, mostly because they now feared theft or mutilation of the volumes. This document states that preservation and replacement efforts should ensure that balance in library materials is maintained and that controversial materials are not removed from the collections through theft, loss, mutilation, or normal wear and tear.

Those libraries that chose to move their copies of the Pernkopf atlas to the special collections portions of their libraries acted in accord with this principle. A library collection development policy is a statement about how a library carries out its mission through the acquisition of information resources for its users. Despite this library school axiom, most American medical school libraries have not established a standard for the selection and treatment of controversial materials in their collections.

This fact, however, does not negate the need for and utility of such a document. The most important aspect of such a policy is its very existence [ 51 ]. Such statements let library users know that their libraries do not endorse the materials they collect. Librarians know that some materials in their libraries contain known untruths and that other materials will be universally acknowledged to be incorrect over time.


Pernkopf Anatomy: Atlas of Topographic and Applied Human Anatomy : Thorax, Abdomen and Extremities

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Eduard Pernkopf

Kagor Medicine and Murder Although never charged with war crimes, Pernkopf spent three years in an Allied prison camp near Salzburg after the war. We thank David J. Two of his former colleagues, Alexander Pickler and Werner Platzer, completed it for its publication. Basic science advances can be obtained with non-human tissue e. This raises quite real ethical questions.


Eduard Pernkopf: The Nazi book of anatomy still used by surgeons

Early life[ edit ] 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. During his time there he became a member of the Student Academic Fraternity of Germany, a student group with a strong German nationalist persuasion. Hochstetter became his mentor and one of his strongest influences.




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