Dissecting the history of anatomy in the Third Reich--1989-2010: A personal account

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

Neuroscience research in the Max Planck Society and a broken relationship to the past: Some legacies of the Kaiser Wilhelm Society after 1948

The development of the brain sciences (Hirnforschung) in the Max Planck Society (MPG) during the early decades of the Federal Republic of Germany (FRG) was influenced by the legacy of its precursor institution, the Kaiser Wilhelm Society for the Advancement of Science (KWG). The KWG's brain science institutes, along with their intramural psychiatry and neurology research programs, were of considerable interest to the Western Allies and former administrators of the German science and education systems in their plans to rebuild the extra-university research society-first in the British Occupation Zone and later in the American and French Occupation Zones. This formation process occurred under the physicist Max Planck (1858-1947) as acting president, and the MPG was named in his honor when it was formally established in 1948. In comparison to other international developments in the brain sciences, it was neuropathology as well as neurohistology that initially dominated postwar brain research activities in West Germany. In regard to its KWG past, at least four historical factors can be identified that explain the dislocated structural and social features of the MPG during the postwar period: first, the disruption of previously existing interactions between German brain scientists and international colleagues; second, the German educational structures that countered interdisciplinary developments through their structural focus on medical research disciplines during the postwar period; third, the moral misconduct of earlier KWG scientists and scholars during the National Socialism period; and, fourth, the deep rupture that appeared through the forced migration of many Jewish and oppositional neuroscientists who sought to find exile after 1933 in countries where they had already held active collaborations since the 1910s and 1920s. This article examines several trends in the MPG's disrupted relational processes as it sought to grapple with its broken past, beginning with the period of reinauguration of relevant Max Planck Institutes in brain science and culminating with the establishment of the Presidential Research Program on the History of the Kaiser Wilhelm Society in National Socialism in 1997.

Renaming of Hallervorden-Spatz disease: the second man behind the name of the disease

Hallervorden–Spatz disease (HSD) has been recently renamed to pantothenate kinase-associated neurodegeneration (PKAN) and neurodegeneration with brain iron accumulation (NBIA), mainly due to the unethical behavior of Julius Hallervorden in the National Socialist (NS) euthanasia program of the Nazi Third Reich. The role of the second name giver in the NS euthanasia program is less clear. Hugo Spatz was the director of the Kaiser Wilhelm Institute for Brain Research in Berlin-Buch during World War II (WWII), renamed to Max Planck Institute after 1945. After the war, he headed the Max Planck Institute for Brain Research in Frankfurt am Main. The present study investigates the potential involvement of Hugo Spatz in the NS euthanasia program. In the present study, we compared a list of euthanasia victims from the German Federal Archive Berlin (30.146 cases published after the reunification of Germany, BArch R179) with the files of the collection of specimens from 1940 until 1945 of Hugo Spatz as listed in the Archive of the Max Planck Society Berlin-Dahlem (n = 305). Furthermore, the old term HSD and the new terms PKAN and NBIA were systematically searched in PubMed from 1946, through January 2019 to evaluate the renaming process from HSD to PKAN/NBIA. Following Hugo Spatz’s death in 1969 growing evidence indicated that he may have taken part in the NS euthanasia program. This study identifies 4 euthanized victims in the patient files of Hugo Spatz from 1940 to 1945, suggesting involvement of Hugo Spatz in the NS euthanasia program. This further strengthens the argument that the former HSD should be exclusively referred to as PKAN or NBIA.

Max Clara: Sweet life in Istanbul with a bitter end 1950-1966 and the search for unethically obtained tissue specimens from his estate in Turkish collections

The aim of this study was to examine the last period of Max Clara's (1899-1966) life in Istanbul (1950-1966) and his scientific activities there. Clara's career before and during the National Socialist (NS) era was extensively studied, however, almost no information is available regarding his late years and his relationship with old colleagues and the academic world after he was dismissed from the academic life in the postwar period. Max Clara's life in Istanbul was based on primary sources from the Istanbul University Archive. Archival documents were supplemented by analyses of the available secondary literature on the history of Istanbul University and refugee scholars in Turkey, literature on Clara, and Clara's publications. Furthermore, an attempt was made to find Clara's histological and anatomical material that he brought with him from Germany, so that the identities of the NS era victims from whom the material were harvested could potentially be reached. Max Clara's life, academic work, and his relations with the outside world during his Istanbul years were clearly and extensively brought into light. However, his histological and anatomical material which was divided into three parts could not be reached due to the reluctance of universities and faculty members who are the new owners of the material. Clara's involvement of unethical practices during the NS era such as medical experiments on prisoners and use of the unethically procured bodies of the executed was further revealed. The analysis of his academic publications revealed that there are great inconsistencies and distortions in themselves and that these publications are not as important as it was thought. Finally, the author considers that international pressure is needed, as in the case of the Pernkopf Atlas, to reach the anatomical and histological material and honor and memorialize the victims.

The Role of German Academic Medicine and Science in the Medical Crimes of the Third Reich and the Shoah: The Continuing Legacy

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.

Anatomy in Nazi Germany: The Use of Victims' Bodies in Academia and Present-Day Legacies

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.

Guest Editor's Remarks: Journal of Biocommunication Special Issue on Legacies of Medicine in the Holocaust and the Pernkopf Atlas

The 2019 Toronto Symposium, THE VIENNA PROTOCOL: Medicine's Confrontation with Continuing Legacies of its Nazi Past, was sponsored by Biomedical Communications, Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto and the Neuberger Centre for Holocaust Education. https://www.holocaustcentre.com/hew-2019/the-vienna-protocol   Prof. Leila Lax, coordinated the Symposium and was inspired by its presenters to create an online collection of Holocaust education resources. She is grateful to the Editor-in-Chief, Gary Schnitz and the Journal of Biocommunication Management Board for their dedication to scholarship, ethics, and the advancement of knowledge, in support of this Special Issue, that deals with contemporary controversies from a dark time in history, that is part of our professional legacy - and memory. This Special Issue is dedicated to the memory of the victims portrayed in the Pernkopf atlas. Image credit: Table of Contents image provided by the Medical University of Vienna, MUW-AD-003250-5-ABB-151.  

Editor's Comments: Journal of Biocommunication Special Issue on Legacies of Medicine in the Holocaust and the Pernkopf Atlas

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.

[Austrian neurologists under the swastika: Julius Wagner-Jauregg-Walther Birkmayer-Franz Seitelberger]

There were three Austrian neurologists with connections to neurology in National Socialism who have been honored by the German Neurological Society (DGN) or its predecessor organizations with honorary membership. From 1928 to 1934 Julius Wagner-Jauregg (1857-1940) was head of the Austrian Alliance for National Regeneration and the Study of Heredity; in at least two publications he advocated eugenic measures and racial hygienic positions as defined by Nazi ideology. As a former member of the Greater German People's Party (Großdeutsche Volkspartei), he applied for membership of the National Socialist German Workers' Party (NSDAP) a few months before his death. Walther Birkmayer (1910-1996) was an early member of the NSDAP, SA, SS and other Nazi organizations. As a staunch supporter of the "movement" he worked from 1938 in the Office of Racial Policy of the Gauleitung of Vienna. In lectures and publications he demanded or recommended forced sterilization for a number of neurological diseases. Due to the classification of his grandmother as "non-Aryan", he had to give up his party and university posts and served as a Wehrmacht physician. After some hard years immediately after the war, he was allowed to continue his career. As a co-discoverer of the effect of L‑DOPA on parkinsonism, he was awarded numerous honorary doctorates and honorary memberships. Franz Seitelberger (1916-2007), a member of an SS unit during the Nazi era, benefited in his research work from the 1950s onwards from specimens obtained in the course of neuropathological "concomitant research" to Nazi "euthanasia". It is to be welcomed that the Austrian Society of Neurology (ÖGN) will soon start a historical project investigating open questions related to the Nazi era.

[German neurology and neurologists during the Third Reich: the aftermath]

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and "denazification", which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics.

Munich anatomy and the distribution of bodies from the Stadelheim execution site during National Socialism

During the reign of National Socialism (NS) anatomical institutes regularly received bodies of executed prisoners in steadily increasing numbers. After 1939, the execution site at Stadelheim prison in Munich supplied not only Munich anatomy but also the institutes in Erlangen, Innsbruck and Würzburg. Due to the disappearance of the Munich body journals, the exact dimension and procedure of body procurement from Stadelheim remained unknown for 70 years. After consultation of a wide range of sources, including rediscovered fragments of the body journals, it is now possible to give an almost comprehensive account of the developments. This article deals with the attempts at recovering information on body procurement from Stadelheim prison during the NS period, which already indicated the significance of Munich anatomy in organizing the distribution of bodies. Thereafter, it addresses the number and distinct groups of Stadelheim prisoners, executed and delivered to the four anatomical institutes, the differences in the handling of their bodies, and the extent to which in particular Munich anatomy profited from the massive increase in executions. Finally, it unveils the role of the Munich Anatomical Institute in distributing those bodies among the anatomies during the Second World War, making it not only the main beneficiary but also the interim center of this process.

Insights into the Freiburg Anatomical Institute during National Socialism, 1933-1945

The Anatomical Institute at the Albert-Ludwigs-Universität Freiburg is among the anatomical departments for which a comprehensive account of its history during National Socialism (NS) is still missing. Previous investigations (such as in: Grün et al., 2002) have revealed the political activities of some anatomists, but, in the absence of relevant body-registers, a more comprehensive examination of the anatomical body procurement has not been attempted. The inspection of records in university and municipal archives allows insight into the activities in the institute within the historical context. The Freiburg Institute shared the experience of the impact of NS politics with other German anatomies. Four anatomists were dismissed because of NS racial discrimination, and chairman von Möllendorf left for political reasons. His successor Nauck's appointment was politically motivated, as he was a staunch Nazi. His colleagues were also members of NS political organizations. Body procurement was controversial between the public and the anatomists in Freiburg prior to and following the Third Reich, and much of the anatomists' efforts focused on the improvement of the body supply. In 1935, and, again during the war, the number of bodies was sufficient for anatomical education. Among the traditional sources of body procurement were increasing numbers of NS victims. Forty-four of them can be identified, among them 21 forced laborers and their children who died of so-called natural causes, and 22 men who had been executed at Stuttgart prison on April 6, 1943. While the victims' names have been ascertained, their biographies still need restoration to ensure an appropriate commemoration.