I was slouched in my lab seat during a lecture on osteopathic principles and practices, doing my best to pay attention but admittedly thinking more about lunch than the blood flow of the head. Suddenly, as I was observing a beautiful illustration of the venous drainage of the brain, a name at the bottom of the screen stunned me.
Image adapted from Pernkopf’s Atlas 3rd Edition.
I knew from my undergraduate work in medical humanities that some of the drawings in this atlas were based in part on the bodies of people executed by the Nazis.
I spent the next hour unable to pay attention. After the lecture, I approached the professor. “I noticed you cited Pernkopf. Are you familiar with his history?” I asked.
He responded that he vaguely understood there was some controversy with Pernkopf, but the clinical importance of the images inclined him to use the illustrations anyway. I thanked him for the lecture and walked away, unsure of what to do, now struck with a moral dilemma I never anticipated.
Eduard Pernkopf (1888-1955) was a brilliant professor of anatomy in Vienna during the Third Reich and active member of the National Socialist Party, also known as the Nazi party. Pernkopf’s most popular and influential work, his four-volume atlas of human anatomy, “Topographische Anatomie des Menschen” (1937-1963) was created with such painstaking detail that it is still used in medical education as well as guidance for surgeons. Early editions of the text include swastikas and other Nazi insignias. After an extensive investigation by the University of Vienna in 1997, the university concluded the following excerpt should be included in front of each copy of the atlas:
“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.”
This vague recommendation has left the medical and ethics community with a messy moral debate. Some say the atlas should be removed from all libraries citing its exploitation of people, possible justification for future atrocities, and inability to separate the product from its maker. Others insist the atlas should remain in use, justifying that good — such as better clinical outcomes — can be derived from its evil, the victims whose bodies are represented in the atlas are best honored by continued use, and its aesthetic value.
Works like Pernkopf’s Atlas are unique because the tangential product can be directly traced to its dark origin, though it is not unique by nature of valuable clinical knowledge being gained by unethical means. For instance, the knowledge for the development of the hepatitis vaccine was developed from physicians knowingly slipping infected feces into the milkshakes of children with intellectual disabilities at Willowbrook State School in Staten Island in the 1950s and 1960s. November of this year will mark the 50th anniversary of the end of the Tuskegee Syphilis Study in which Black men with syphilis were knowingly untreated in an attempt to better understand the pathogenesis of the disease. While Tuskegee and Willowbrook may be memorable to many readers, Harriet A. Washington’s Medical Apartheid points out similar experiments occurred long before Tuskegee and continued long after. Further, for each artist or scientist known to have had an ethically troubled past, there are almost certainly more whose skeletons have stayed quietly in the closet.
Calls for removing this atlas and similar works skirt the stark reality that so much of the foundation of western medical science is bathed in blood, and by receiving medical treatment in this society we are benefiting from past atrocities. Medical knowledge derived from unethical origins cannot be simply cut out because to do so would call for a resection of the structure of western medicine itself. Doing away with products of unethical of biomedical science and research instead directly harms patients by reducing useful clinical knowledge and it removes the medical community’s ability to acknowledge, discuss, and reconcile its history.
The back-and-forth arguments about whether morally questionable science and art should be removed also circles around a crucial variable: the context under which they are used. It is wrong to use Pernkopf’s Atlas as an educational tool if no one in the room knows the context of its creation. (In the lecture in which I saw the Pernkopf reference, I was likely the only person in the room of nearly 100 current and future medical doctors who knew the story of the atlas.) Changing the framework under which this information is disseminated, however, changes the ethics of its use.
Too often, debates like the one surrounding Pernkopf’s Atlas have centered around the false dichotomy of remove or not remove. Much less attention has focused on the more nuanced — and important — question: If this product is to be used, how can it be used ethically?
The absence of knowledge surrounding Pernkopf’s Atlas in the medical community is a salient representation of the lack of historical context given during medical training. The atlas is a product of immense scientific and clinical value, but it should also be used to instruct medical students and doctors about the influence of external political pressure on medicine. The atlas should be used in a way that recognizes its scientific value but also teaches doctors and students the relevance of medical ethics, history, and most importantly acknowledges the profound travesty the victims of the period underwent.
My professor knew Pernkopf’s Atlas was controversial, but was not aware of the extent of the controversy. After a few conversations and emails, and once he realized I was not in the business of stirring up trouble for the sake of it, he sent out an email to the entire class outlining some of the history of the Pernkopf Atlas and acknowledging the tragic source of its origins.
There will never be unanimous agreement about whether Pernkopf’s Atlas should be used. Instead, more attention needs to focus on how it and similar works will be used. Pernkopf’s Atlas was created by a man who was both an anatomical genius and an avowed Nazi, using victims of one of the darkest periods of human history to create elegant and indispensable anatomical illustrations. The historical context which allowed such a phenomenon to occur as well as a thorough acknowledgement of the atrocities should always accompany the recognition of the atlas’s benefit to medicine and those who gave their health, their dignity, and their lives to further medical advancements.
Chad Childers is a third-year medical student at Marian University College of Osteopathic Medicine in Indianapolis.