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Keet K, Kramer B. Advances in Digital Technology in Teaching Human Anatomy: Ethical Predicaments. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1388:173-191. [DOI: 10.1007/978-3-031-10889-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seidelman W. The Role of German Academic Medicine and Science in the Medical Crimes of the Third Reich and the Shoah: The Continuing Legacy. THE JOURNAL OF BIOCOMMUNICATION 2021; 45:E11. [PMID: 36407932 PMCID: PMC9140262 DOI: 10.5210/jbc.v45i1.10852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite the revelations of the Nuremberg Medical Trial and subsequent prosecutions, the reality is that, with particular respect to medicine and the role of leading academic and scientific institutions during the so-called "Third Reich," the postwar period war was marked by a "Great Silence." With few exceptions, this silence continued until the 1980's, when increasing systematic scholarly research and inadvertent discoveries revealed the significant role played by the German and Austrian medical profession during the Nazi period and the Shoah. The discoveries included body parts of victims of Nazi terror in the collections of university institutes of anatomy and scientific research. The Pernkopf Atlas of Human Anatomy represents a legacy from Nazi medicine. Although it includes images from Nazi victims, its accuracy makes it a valued resource in surgery. The Vienna Protocol is a new halachic responsum on the question of what to do with newly discovered remains from Nazi victims and their data, and can provide guidance in the ethical reasoning on whether to use the Pernkopf atlas.
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Affiliation(s)
- William Seidelman
- Department of Family and Community Medicine, Temerty Faculty of
Medicine, University of Toronto, Toronto, Ontario,
Canada
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Hildebrandt S. Anatomy in Nazi Germany: The Use of Victims' Bodies in Academia and Present-Day Legacies. THE JOURNAL OF BIOCOMMUNICATION 2021; 45:E12. [PMID: 36407926 PMCID: PMC9140205 DOI: 10.5210/jbc.v45i1.10848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
After decades of denial, German academic medicine was reluctant to accept responsibility for its complex collaboration with the Nazi regime. Consequently, much of this history needs further detailed exploration, as legacies from this history still exist in the form of "Books, Bones and Bodies." Specifically, this concerns the legacies of anatomists' use of bodies of Nazi victims in teaching and research, as "data" have become anatomical knowledge and specimens from victims continue to be discovered.
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Affiliation(s)
- Sabine Hildebrandt
- Division of General Pediatrics, Department of Medicine,
Boston Children's Hospital, Boston,
Massachusetts
- Department of Global Health and Social Medicine, Harvard
Medical School, Boston, Massachusetts
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Lax L. Towards Informed Use of the Pernkopf Atlas. THE JOURNAL OF BIOCOMMUNICATION 2021; 45:E15. [PMID: 36407933 PMCID: PMC9138628 DOI: 10.5210/jbc.v45i1.10851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Knowledge of the dark history and inherent ethical dilemmas of Pernkopf's atlas is essential to individual decisions on use. Seventy-five years after the Holocaust, the legacy of Pernkopf's Atlas of Topographical and Applied Human Anatomy continues to unfold. Informed use of the atlas needs to be integrated in academia and in practice. This paper advocates for the adoption of The Vienna Protocol and improving informed use of the atlas by: (1) updating and inserting an information letter in as many volumes as possible, so that the history can be known before use; (2) conducting and publishing a research study within the medical art community, to examine knowledge of the history of the atlas and elevate awareness; and (3) creating a museum archive and permanent exhibition of the original anatomical illustrations, to document historical facts, disseminate visual evidence, and illuminate embedded controversies. Moving towards informed use, in these ways, provides opportunities for continued ethical discourse, personal reflection and future Holocaust education. Through informed use we memorialize and pay tribute to the Nazi victims portrayed in the atlas.
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Affiliation(s)
- Leila Lax
- Temerty Faculty of Medicine, University of Toronto
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Schnitz GW. Editor's Comments: Journal of Biocommunication Special Issue on Legacies of Medicine in the Holocaust and the Pernkopf Atlas. THE JOURNAL OF BIOCOMMUNICATION 2021; 45:e1. [PMID: 36407931 PMCID: PMC9139793 DOI: 10.5210/jbc.v45i1.10831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Welcome to the Journal of Biocommunication’s Special Issue 45-1. We have designated this publication as a JBC “Special Issue,” as it is devoted entirely to one topic. Our current Special Issue includes articles and commentaries all related to Eduard Pernkopf’s, Atlas of Topographical and Applied Human Anatomy. Our authors have provided in-depth discussions about the Pernkopf’s atlas’ dark history, the uncertain origin of cadavers used as references for the atlas, and medical crimes of the Third Reich.
Seven of the articles are authored by some of the world’s leading historians and authorities on the subject of the Pernkopf atlas and the abuses of Nazi medicine. These authors presented papers at a Holocaust Education Week Symposium that was held on Nov. 10, 2019, at the Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. This landmark Symposium was called, “The Vienna Protocol: Medicine’s Confrontation with Continuing Legacies of its Nazi Past.” The Symposium faculty included Susan Mackinnon, MD, Rabbi Joseph Polak, William E. Seidelman, MD, Sabine Hildebrandt, MD, Philip Berger, MD, Anne Agur, PhD, and Leila Lax, PhD, who also served as the Symposium coordinator and host.
Table of Contents image credit: Medical University of Vienna, MUW-AD-003250-5-ABB-81.
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Yee A, Li J, Lilly J, Hildebrandt S, Seidelman WE, Brown D, Kopar P, Coert JH, Mackinnon SE, Israel HA. Oral and maxillofacial surgeons' assessment of the role of Pernkopf's atlas in surgical practice. Ann Anat 2020; 234:151614. [PMID: 33171220 DOI: 10.1016/j.aanat.2020.151614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of the Pernkopf atlas of human anatomy in surgery presents ethical challenges due to the author's association with the Nazi regime and the potential depiction of victims of this regime. The atlas was of particular utility to two surgical specialties: nerve surgeons and oral and maxillofacial surgeons. The representation of peripheral nerves and complex head and neck anatomy is probably unequaled in any other atlas of anatomy. While the ethical implications of the use of Pernkopf's atlas among nerve surgeons have been previously assessed, this study focuses on the volume dedicated to detailed images of head and neck dissections, and the ethical implications of using this atlas by oral and maxillofacial surgeons. OBJECTIVE To (1) assess the role of the Pernkopf atlas in oral and maxillofacial surgeons' current practice and (2) determine whether a proposal of four conditions would provide ethical guidance for use in surgery and education. METHODS Members of three American oral and maxillofacial surgical societies (ACOMS, ASTMJS, AAOMS) were surveyed and 181 responses collected. The survey introduced the historical origin of the Pernkopf atlas, and respondents were asked whether they would use the atlas under specific conditions that could be a recommendation for its ethical handling. An anatomical plate comparison between Netter's and Pernkopf's atlases was performed to compare accuracy and surgical utility. RESULTS Forty-nine percent of respondents were aware of the Pernkopf atlas, and 9% of respondents were currently using it. Amongst those aware of the historical facts, 42% were comfortable using the atlas, 33% uncomfortable, and 25% undecided. The four conditions involving disclosure, bioethical and religious considerations, and remembrance led to 75% of those "uncomfortable" and "undecided" becoming "comfortable" with use. CONCLUSIONS Amid recent developments and controversy regarding the Pernkopf atlas, a proposal detailing conditions for an ethical approach may provide guidance in surgical planning and education. Furthermore, this approach has implications for the future preparation and publication of anatomical atlases and their use.
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Affiliation(s)
- Andrew Yee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Jessica Li
- Oral and Maxillofacial Surgery, Touro College of Dental Medicine, New York Medical College, Hawthorne, NY, USA
| | - Joshua Lilly
- Oral and Maxillofacial Surgery, Touro College of Dental Medicine, New York Medical College, Hawthorne, NY, USA
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - William E Seidelman
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Doug Brown
- Center for Humanism and Ethics in Surgical Specialties, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Piroska Kopar
- Center for Humanism and Ethics in Surgical Specialties, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - J Henk Coert
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, Netherlands
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Howard A Israel
- Oral and Maxillofacial Surgery, Touro College of Dental Medicine, New York Medical College, Hawthorne, NY, USA
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Yee A, Zubovic E, Yu J, Ray S, Hildebrandt S, Seidelman WE, Polak RJA, Grodin MA, Coert JH, Brown D, Kodner IJ, Mackinnon SE. Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study. Surgery 2019; 165:860-867. [PMID: 30224084 DOI: 10.1016/j.surg.2018.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.
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Affiliation(s)
- Andrew Yee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shuddhadeb Ray
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - William E Seidelman
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, ON, Canada
| | - Rabbi Joseph A Polak
- School of Public Health, Boston University, MA, USA; Elie Wiesel Center for Jewish Studies, Boston University, MA, USA; Rabbinical Court of New England, Boston, MA. USA
| | - Michael A Grodin
- School of Public Health, Boston University, MA, USA; Elie Wiesel Center for Jewish Studies, Boston University, MA, USA
| | - J Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center, Utrecht, Netherlands
| | - Douglas Brown
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ira J Kodner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Czech H, Druml C, Weindling P. Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present. Wien Klin Wochenschr 2018; 130:159-253. [DOI: 10.1007/s00508-018-1343-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Yee A, Coombs DM, Hildebrandt S, Seidelman WE, Coert JH, Mackinnon SE. Nerve Surgeons’ Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice. Neurosurgery 2018; 84:491-498. [DOI: 10.1093/neuros/nyy159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/28/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Yee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - William E Seidelman
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Henk Coert
- Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Coombs DM, Peitzman SJ. Medical Students’ Assessment of Eduard Pernkopf’s Atlas: Topographical Anatomy of Man. Ann Anat 2017; 212:11-16. [DOI: 10.1016/j.aanat.2017.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
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Mages KC, Lohr LA. Body of evidence: integrating Eduard Pernkopf's Atlas into a librarian-led medical humanities seminar. J Med Libr Assoc 2017; 105:173-178. [PMID: 28377682 PMCID: PMC5370610 DOI: 10.5195/jmla.2017.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Anatomical subjects depicted in Eduard Pernkopf’s richly illustrated Topographische Anatomie des Menschen may be victims of the Nazi regime. Special collections librarians in the history of medicine can use this primary resource to initiate dialogs about ethics with medical students. Case Presentation Reported here is the authors’ use of Pernkopf’s Atlas in an interactive medical humanities seminar designed for third-year medical students. Topical articles, illustrations, and interviews introduced students to Pernkopf, his Atlas, and the surrounding controversies. We aimed to illustrate how this controversial historical publication can successfully foster student discussion and ethical reflection. Conclusions Pernkopf’s Atlas and our mix of contextual resources facilitated thoughtful discussions about history and ethics amongst the group. Anonymous course evaluations showed student interest in the subject matter, relevance to their studies, and appreciation of our special collection’s space and contents.
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Olry R, Haines DE. Hallervorden-Spatz Disease: Did One Set the Fox to Mind the Geese? JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2015; 24:420-425. [PMID: 26444924 DOI: 10.1080/0964704x.2015.1028219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Régis Olry
- a Department of Anatomy , Université du Québec à Trois-Rivières , Trois-Rivières , Canada
| | - Duane E Haines
- b Department of Neurobiology and Anatomy , Wake Forest School of Medicine , Winston-Salem , NC , USA
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Olry R. Anatomical eponyms, Part 2: The other side of the coin. Clin Anat 2014; 27:1145-8. [DOI: 10.1002/ca.22439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 06/28/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Regis Olry
- Department of Anatomy; Université du Québec à Trois-Rivières; Trois-Rivières Canada
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Abstract
The multi-faceted nature of modern anatomy comes as a surprise to many, especially when confronted by such seemingly different topics as cadavers and human embryo research. However, even these disparate facets of anatomy are linked by common underlying ethical considerations. This article traces historical views of anatomy and places them alongside the more contemporary dimensions of whole-body plastination, use of human material obtained under unethical circumstances, and human embryo research. These dimensions introduce issues of respect, human dignity, consent, scientific integrity, and societal expectations.
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Affiliation(s)
- D Gareth Jones
- Department of Anatomy and Structural Biology, University of Otago, Dunedin, New Zealand.
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Hildebrandt S. How the Pernkopf controversy facilitated a historical and ethical analysis of the anatomical sciences in Austria and Germany: A recommendation for the continued use of the Pernkopf atlas. Clin Anat 2006; 19:91-100. [PMID: 16425297 DOI: 10.1002/ca.20272] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eduard Pernkopf's Topographical Anatomy of Man has been a widely used standard work of anatomy for over sixty years. International inquiries about the National Socialist (NS) political background of Eduard Pernkopf and the use of bodies of NS victims for the atlas were first directed at the University of Vienna in 1996. A public discussion about the further use of the book followed and led to the creation of the Senatorial Project of the University of Vienna in 1997. This historical research project confirmed the strong NS affiliation of Pernkopf and revealed the delivery of at least 1,377 bodies of executed persons to the Anatomical Institute of Vienna during the NS time. The possible use of these bodies as models cannot be excluded for up to half of the approximately 800 plates in the atlas. In addition tissue specimens from NS victims were found and removed from the collections of the Viennese Medical School and received a burial in a grave of honor. The Pernkopf controversy facilitated the historical and ethical analysis of the anatomical sciences in Austria and Germany during the NS regime. The continued use of the Pernkopf atlas is not only justifiable but desirable as a tool in the teaching of anatomy, history, and ethics.
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Affiliation(s)
- Sabine Hildebrandt
- Division of Anatomical Sciences, Office of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan 48109-0608, USA.
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Hubbard C. Eduard Pernkopf's atlas of topographical and applied human anatomy: the continuing ethical controversy. THE ANATOMICAL RECORD 2001; 265:207-11. [PMID: 11745104 DOI: 10.1002/ar.1157] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C Hubbard
- Department of Biological Sciences, Northern Illinois University, DeKalb 60115, USA.
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Abstract
The human body has been depicted in ancient cave-paintings, in primitively sculpted figures, and through all the ages in various forms of artistic expression. The earliest medical texts were descriptive but not illustrated. Later, as it became clear that knowledge of the human body and all its systems was essential to the practice of healing, texts were accompanied by illustrations which became an integral part of the teaching process. The illustrators included artists, whose interest was primarily artistic, but who were sometimes employed by surgeons or physicians to illustrate their texts. Occasionally, the physicians or scientists accompanied their texts with their own illustrations, and in the last century, medical illustration, in its infinite variety of techniques, has been developed as a profession in its own right. As knowledge was extended, permitted by social and cultural change, as well as by technological advances, the types of illustrations have ranged from gross anatomy through dissections showing the various organ systems, histological preparations, and radiological images, right up to the computerized digital imagery that is available today, which allows both static and dynamic two- and three-dimensional representations to be transmitted electronically across the world in a matter of seconds. The techniques used to represent medical knowledge pictorially have been as varied as the illustrators themselves, involving drawing, engraving, printing, photography, cinematography and digital processing. Each new technique has built on previous experience to broaden medical knowledge and make it accessible to an ever-widening audience. This vast accumulation of pictorial material has posed considerable problems of storage, cataloguing, retrieval, display and dissemination of the information, as well as questions of ethics, validity, manipulation and reliability. This paper traces these developments, illustrating them with representative examples drawn from the inexhaustible store of documents accumulated over more than two millennia.
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Affiliation(s)
- J Tsafrir
- Medical Library, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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