Anatomy, Ethics, and the Pernkopf Atlas

Should Unethical Research Be Used?

Aug 16, 2009 Jeffrey Willett

Although the Pernkopf Atlas has been used by physicians for almost 70 years, allegations about the artists and the models have raised disturbing ethical questions.

The Atlas of Topographical and Applied Human Anatomy by Eduard Pernkopf (commonly known as the Pernkopf Atlas) has been widely used by physicians for almost 70 years. The Atlas includes meticulous diagrams of every part of the human body. In 1996, allegations were raised that some of the artists who produced the anatomical illustrations were National Socialists (Nazis), while the models were rumored to be political prisoners and Holocaust victims.

Nazi Influences in the Pernkopf Atlas

The Pernkopf Atlas was first produced in Austria during the late 1930s and revised throughout World War II. Pernkopf was a known member of the Nazi party. After the Germans invaded Austria in 1938, Pernkopf was appointed Dean of the Medical Faculty at the University of Vienna. Pernkopf used his influence not only to remove Jews from the faculty, but also to hire professors who would swear allegiance to Nazi Germany.

According to Atlas (2001), early editions included subtle references to the Nazi party. An artist named Erich Lepier incorporated a swastika inside his signature. Another artist (Karl Endtresser) replaced the “ss” in his name with an exaggerated lightning bolt symbol meant to represent the German “S.S,” or military police.

Did Pernkopf Use Holocaust Victims As Models?

In 1996, a Letter to the Editor published in the Journal of the American Medical Association (JAMA) alleged that some of Pernkopf's models came from “Gestapo execution chambers in Linz, Munich, and Prague.” Furthermore, some dissected body parts supposedly came from Jewish Holocaust victims.

In 1997, the University of Vienna appointed a commission to investigate these allegations. The Vienna Commission spent three years studying records from the University of Vienna. Approximately 12,300 cadavers (including children) had been donated to the Anatomy Institute from 1938 to 1945, the period when the Atlas was developed. The Vienna Commission concluded that Pernkopf likely used 1,377 German political prisoners to illustrate his Atlas, but could not say whether Holocaust victims had been used, as only 8 cadavers bore signs of Jewish heritage.

The Ongoing Ethical Debate

The Pernkopf Atlas has been used all around the world, including in Israel. It has gone through several editions and continues to be published because of its scientific merit. Nevertheless, the ethical debate continues as questions like these are raised:

• Should unethical data ever be used?
• Is using Nazi medical research ethical?
• If unethical data is not used, are the victims' deaths robbed of any meaning?
• Would banning the Atlas be a form of censorship?

The Ethics of Scientific Inquiry

Scientific inquiry has long been torn between legitimate ends and unethical means. The first great anatomist, Andreas Vesalius (1514–1564), dissected bodies that had been stolen from graveyards. Just like Pernkopf, Vesalius did not get permission from his models. Nevertheless, the book that resulted from his research (On the Structure of the Human Body) is still considered a landmark of medical research and has not been banned.

Over the centuries, cures for cholera, yellow fever, malaria, and polio have been obtained through questionable research. Faden (1996) estimated that 90% of all U.S. drug toxicity studies conducted until the 1970s used prisoners as research subjects. In the 20-year period from 1977 to 1996, the U.S. Food and Drug Administration (FDA) inspected 4,154 clinical trials; in 53% of those studies, experimenters had not told subjects that they were being experimented upon. None of the drugs produced by these unethical means, however, have been removed from the marketplace.

Is it Ethical to Use the Atlas?

At the end of World War II, neither Pernkopf nor any of his associates were prosecuted for war crimes. All symbols related to the Nazi party have been removed from current editions of the Atlas.

The Vienna Commission advised that it was “the individual user's ethical responsibility to decide whether” the Atlas should be used. Out of 125 libraries belonging to the American Association of Medical Colleges, only 1 withdrew the Atlas from circulation after reviewing the commission findings. Thus, it is up to each user to decide if the Pernkopf Atlas is a classic of medical research, or a work worthy only of condemnation.

References

Atlas MC. Ethics and access to teaching materials in the medical library: the case of the Pernkopf atlas. Bull Med Libr Assoc 2001 January; 89(1):51–58.

Faden RR (Ed). 1996. Prisoners: captive research population. In: The Human Radiation Experiments: Final Report of the President’s Advisory Committee (pp. 263–283). New York: Oxford University Press.

Israel HA, Seidelman WE. Nazi origins of an anatomy text: the Pernkopf atlas. JAMA 1996 (Nov 27); 276(20):1633–1634.

The copyright of the article Anatomy, Ethics, and the Pernkopf Atlas in Scientific Inquiry is owned by Jeffrey Willett. Permission to republish Anatomy, Ethics, and the Pernkopf Atlas in print or online must be granted by the author in writing.

Anatomical Illustration of the Heart