Nerve Surgeons' Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice

(Reprinted with permission from NEUROSURGERY, Volume 84, Number 2, February 2019).

Dissecting the History of Anatomy in the Third Reich -: 1989-2010: A Personal Account

(Reprinted with permission from Annals of Anatomy Vol. 194, No. 3, 2012).

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

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.

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

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.

Posthumous Testimony for Dr. Leo Gross and his Family / Restoration of the 'Lost' Biography of a Physician Victim of the Holocaust

At a time when the last direct witnesses of the Holocaust are passing, new approaches to the restoration of 'lost' biographies of victims need to be considered. This investigation describes the potential of an international collaboration including surviving family members. Archival documents discovered in Jerusalem in 1983 concerned a discussion on the cancellation of a medical licence for a German Jewish physician, Dr. Leo Gross of Kolberg, who had been disenfranchised from medical practice under Nazi law. After applying for a medical licence during a 1935 visit to Palestine, Gross remigrated to Germany, where he was imprisoned in a concentration camp. No further information was found until 2014, when a group of scholars linked a variety of archival and internet-accessible sources and located a nephew of Gross. The nephew's testimony, cross-referenced against data from other sources, enabled the reconstruction of the 'lost' biography of his uncle and family, in fact a posthumous testimony. The resulting narrative places Dr. Leo Gross within his professional and social network, and serves his commemoration within this context of family and community. The restored biography of Dr. Leo Gross presents an exemplary case study for the future of Holocaust testimony.

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

This paper is a personal narrative of involvement with the revelations of the use of anatomical and pathological specimens of victims of Nazi terror. The narrative documents responses to the question of the retention and use of anatomical and pathological specimens from victims of Nazi terror by leading academic and scientific institutions and organizations in Germany and Austria including the government of the Federal Republic of (West) Germany, the University of Tübingen, the University of Vienna, the Max Planck Society and the Anatomische Gesellschaft. It begins with the public revelations of 1989 and concludes with the September 2010 Symposium on the History of Anatomy during the Third Reich at the University of Würzburg. The narrative documents a 22-year transition in attitude and responses to the investigation and documentation of the history of anatomy and pathology during the Third Reich. The chronicle includes the 1989 proposed "Call for an International Commemoration" by the author, together with the bioethicist Professor Arthur Caplan, on the occasion of the planned burial of the misbegotten specimens and the responses to that proposal.

Nuremberg lamentation: for the forgotten victims of medical science

Fifty years after the Nuremberg medical trial there remain many unanswered questions about the role of the German medical profession during the Third Reich. Other than the question of human experimentation, important ethical challenges arising from medicine in Nazi Germany which have continuing relevance were not addressed at Nuremberg. The underlying moral question is that of the exercise of professional power and its impact on vulnerable people seeking medical care. Sensitisation to the obligations of professional power may be achieved by an annual commemoration and lament to the memory of the victims of medical abuse which would serve as a recurring reminder of the physician's vulnerability and fallibility.

Whither Nuremberg?: medicine's continuing Nazi heritage

The medical crimes of the Hitler regime are commonly perceived to have been committed by a few demonic physicians working in isolation from the mainstream of the German medicine. The success of this myth has imperiled the value system of medicine today. The World Medical Association (WMA), established to address the ethical challenges arising from the German tragedy, has itself been compromised by this legacy. The leadership of the WMA has included doctors once associated with the Nazi SS terror organization and linked to crimes prosecuted at Nuremberg. Despite these recent revelations the WMA has yet to address the ethical issues raised by its own Nazi heritage or to pay homage to the victims of the Nazi regime.

Mengele Medicus: Medicine's Nazi Heritage

Nazi medicine is commonly considered to be an aberration that began and ended with the horrors of the Hitler regime. But its beginnings were more gradual and its legacy more pernicious. Data derived from research conducted on unknowing and unwitting subjects in death camps continue to be cited in authoritative contemporary medical literature. Nazi medicine has become a part of the professional genotype of modern medicine. This continuing influence of Nazi medicine raises profound questions for the epistemology and morality of medicine.

Medical selection: Auschwitz antecedents and effluent

Medical selection in Auschwitz represents the penultimate application of the traditional paradigm of medicine: the physician as gatekeeper and decision maker. The historical evolution of that role is considered in the context of public health, medical police, quarantine, and immigration. In Nazi Germany the physician was assigned responsibility for selection on behalf of the state. The ethical implications of medical selection are considered in the context of medicine today in an age of sophisticated biotechnology, constrained resources, and an aging population; an age in which the medical profession has yet to establish a fundamental system of values.

In memoriam: medicine's confrontation with evil

The proposed public burial of anatomical specimens derived from victims of the Nazis provides an occasion for the medical community worldwide to confront this legacy and the profession's ongoing potential for evil.

Medical selection: Auschwitz antecedents and effluent

Medical selection in Auschwitz represents the penultimate application of the traditional paradigm of medicine; the physician as gatekeeper, and decision maker. The historical evolution of that role is considered in the context of public health, medical police, quarantine and immigration. In Nazi Germany the physician was assigned responsibility for selection on behalf of the state. The ethical implications of medical selection are considered in the context of medicine today in an age of sophisticated biotechnology, constrained resources, and an aging population; an age in which the medical profession has yet to establish a fundamental system of values.

Value of the gram-stained urethral smear in the management of men with urethritis

The value of the gram-stained urethral smear in clinical decision-making was assessed in a study of 250 men attending a clinic for sexually transmitted diseases. Of the 250 men, 132 (52.8%) had objective evidence of urethritis. Neisseria gonorrhoeae and/or Chlamydia trachomatis was isolated from 94 patients (37.6%). No pathogens were isolated from 38 patients (15.2%) who were diagnosed as having urethritis. Although the specificity (0.95) and positive predictive value (0.95) of the gram smear for culture-proved urethral infection was high, the relatively low sensitivity (0.66) and negative predictive value (0.63), led us to conclude that the test was of limited value in diagnosis and therapeutic decision-making when the patient was first seen. The decision to treat a patient should be based on a reliable history of dysuria and/or a urethral discharge in a patient at risk of infection, with or without an observable urethral discharge. Nevertheless, a gram smear should be done for all patients who are diagnosed presumptively as having urethritis, because it may be the only objective evidence of urethritis.

The professional origins of Dr. Joseph Mengele

Images

Moving a private community family practice to a hospital-based teaching unit: patients' response

Patients' response to the relocation of an established practice from the community to a hospital-based teaching unit was measured at the end of one year. Questionnaires were sent to a randomly selected group of adult patients, asking about their impressions of the new clinic or their reasons for switching practices. The major reason cited for changing practices was the change of geographic location, rather than the change from community to teaching practice. Although most patients had been seen by residents, ratings were unrelated to the number of residents or staff administering care.

Voluntary review in family practice

Compulsory examinations and reviews are becoming an increasingly important part of the physician's professional life. Four examples of voluntary review procedures for family physicians are described. Implementation of regular voluntary review processes could offset the imposition of such procedures through legislation.

A family-oriented approach to pediatric care

The REACH Centre in Vancouver offers an innovative approach to pediatric care. The child is considered to be part of an eco-system in which the family is of chief importance. Family centered care is the theme of the approach with a team of health professionals sharing responsibilities.