Oral and maxillofacial surgeons' assessment of the role of Pernkopf's atlas in surgical practice

What is a vulva?

What exactly is a vulva? The question remains unresolved. Some sources consider the clitoris, labia, mons pubis, perineum, or vagina to be components of the vulva, while other sources do not. Indeed, disagreement exists among international anatomical and clinical societies with regard to what precise structures form the human vulva. The obfuscation regarding the anatomy of the vulva and, likewise, inconsistencies in vulva-related anatomical terminology have adversely affected communication, research, and healthcare. Therefore, this review was undertaken to provide a comprehensive and critical analysis regarding the past, present, and potential future of vulvar anatomy and vulva-related anatomical terminology. The review reveals that confusion regarding the specific gross anatomical structures that form the vulva has persisted for thousands of years. The review provides novel information regarding the etymology of vulva, contributes important historical context regarding vulva, and gives details regarding related anatomical terminology including clitoris, hymen, labia majora, labia minora, mons pubis, pudendum, pudendum femininum/muliebre, uterus, vagina, et cetera. The review highlights disagreement regarding what specific structures comprise a vulva, identifies sexual bias in anatomical terminology and among noteworthy anatomical resources, and offers novel perspectives regarding anatomical terminology-especially anatomical terminology that relates to the external genitalia. What specific anatomical structures comprise the vulva? This review provides a comprehensive and critical analysis regarding the past, present, and potential future of vulvar anatomy and vulva-related anatomical terminology.

Before and After I Knew: Disclosure, Respect, Gratitude, and Solemnity

The Pernkopf anatomical atlas has contributed significantly to the specialty of nerve surgery through its infiltration in surgical training and the development of novel procedures due to the accurate depiction of the nervous system. Until the recent advancements of the Pernkopf controversy, nerve surgeons have struggled with the ethical dilemma presented with its use in surgery and clinical practice. In this article, we explore a personal story and reflection by an individual nerve surgeon, their contribution to the advancement of the Pernkopf controversy, and how different professional domains (surgery, anatomy, ethics, religion, and education) were able to collaborate to address the historical crimes against humanity and issues in the anatomical sciences. This required a structured approach to address this ethical dilemma in surgery, which included (1) an assessment of the use of the Pernkopf atlas in specific surgical specialties (nerve surgery and oral and maxillofacial surgery) and (2) the development of a graduated ethical framework with a religious framework (the Vienna Protocol), if the Pernkopf atlas was to be used in surgery. These studies are reviewed in the context of evolving paradigms in nerve surgery (nerve repair, grafting, and transfers) and influence of anatomy in the advancement of this surgical specialty.

Towards Informed Use of the Pernkopf Atlas

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.

Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.