"The Vienna Protocol: Medicine's confrontation with continuing legacies of its Nazi past,".

This letter to the editor describes a symposium on The Vienna Protocol and the legacy of the Pernkopf atlas, which took place as part of the annual Neuberger Holocaust Education week, in Toronto, Canada, on 10. November 2019.

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

BACKGROUND: Pernkopf's atlas of Anatomy contains anatomical plates with detailed images of the peripheral nerves. Its use is controversial due to the author's association with the "Third Reich" and the potential depiction of victims of the Holocaust. The ethical implications of using this atlas for informing surgical planning have not been assessed. OBJECTIVE: To (1) assess the role of Pernkopf's atlas in nerve surgeons' current practice and (2) determine whether a proposal for its ethical handling may provide possible guidance for use in surgery and surgical education. METHODS: Members of American Society for Peripheral Nerve and PASSIO Education (video-based learning platform) were surveyed and 182 responses collected. The survey introduced the historical origin of Pernkopf's atlas, and respondents were asked whether they would use the atlas under specific conditions to serve as a recommendation for its ethical handling. An anatomical plate comparison between Netter's and Pernkopf's atlases was performed to compare anatomical accuracy and surgical utility. RESULTS: Fifty-nine percent of respondents were aware of Pernkopf's atlas, with 13% currently using it. Aware of the historical facts, 69% were comfortable using the atlas, 15% uncomfortable, and 17% undecided. Additional information on conditions for an ethical approach to the use of the atlas led 76% of those "uncomfortable" and "undecided" to becoming "comfortable" with use. CONCLUSION: While the use of Pernkopf's atlas remains controversial, a proposal detailing conditions for an ethical approach in its use provides new guidance in surgical planning and education.

Medical Students' Assessment of Eduard Pernkopf's Atlas: Topographical Anatomy of Man.

INTRODUCTION: To date, there has been no study examining the perceptions of first-year medical students regarding Eduard Pernkopf's atlas, particularly during their study of gross anatomy and prior to coursework in medical ethics. We present a discussion of Pernkopf's Atlas: Topographical Anatomy of Man from the perspective of U.S. medical students, and sought to determine whether medical students view Pernkopf's Topographical Anatomy of Man as a resource of greater accuracy, detail, and potential educational utility as compared to Netter's Atlas of Human Anatomy. METHODS: The entire first-year class at Drexel University College of Medicine (265 students) was surveyed at approximately the midpoint of their gross anatomy course and 192 responses were collected (72% response rate). RESULTS: Of these, 176 (95%) were unaware of the existence of Pernkopf's atlas. Another 71% of students found the Pernkopf atlas more likely complete and accurate, whereas 76% thought the Netter atlas more useful for learning (p<.001). When presented with a hypothetical scenario in which the subjects used in creating Pernkopf's atlas were donated, or unclaimed, but with knowledge that Pernkopf was an active member of the Nazi party, 133 students (72%) retained their original position (p=.001). About 94% desired discussion of Pernkopf within a medical school bioethics course. The relationship between level of self-reported knowledge and whether or not students would advocate removal of the atlas was statistically significant (p=.013). CONCLUSION: Discussing ethical violations in medical history, especially the Pernkopf atlas, must attain a secure place in medical school curricula, and more specifically, within a bioethics course.

Body of evidence: integrating Eduard Pernkopf's Atlas into a librarian-led medical humanities seminar.

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.

Engaging with plastination and the Body Worlds phenomenon: a cultural and intellectual challenge for anatomists.

Body Worlds, the international plastination phenomenon, has proved immensely popular with audiences worldwide. Never before has the human body been exposed to public gaze in such an accessible and intriguing manner. Dissected body parts feature alongside whole-body plastinates with their life-like poses ranging from those with Renaissance motifs to others with highly contemporary themes. However, the exhibitions and their creator, Gunther von Hagens, have astounded many, including anatomists, some of whom find the unconventional display of human bodies unethical and offensive. The voyeuristic nature of Body Worlds and the uneasy balance between entertainment and education have proved problematic for anatomists. Von Hagens himself is a polarizing figure, pursuing his dream of "democratizing anatomy" with little regard for the conventions of academia. While valid ethical objections can be raised against some aspects of the exhibitions, we argue that wholesale rejection of them is unwarranted. In arriving at this conclusion we assess the ethical and educational issues involved. We divide the whole-body plastinates into four categories, ranging from those illustrating structural and functional relationships to those with artistic and humanistic aspirations rather than anatomical ones. We conclude that anatomists need to face up to the opportunities and challenges posed by the Body Worlds phenomenon, utilizing what is being presented to the general public and adapting this in teaching and research.

Anatomical investigations and their ethical dilemmas.

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.

Bodyworlds and the ethics of using human remains: a preliminary discussion.

Accepting the claim that the living have some moral duties with regard to dead bodies, this paper explores those duties and how they bear on the popular travelling exhibition Bodyworlds. I argue that the concept of informed consent presupposes substantial duties to the dead, namely duties that reckon with the meaning of the act in question. An attitude of respect and not regarding human remains as mere raw material are non-alienable substantial duties. I found the ethos of Bodyworlds premature but full of promises such as public attitudes to organ donations. At the practical level I conclude that Bodyworlds should use only willed donations or unclaimed bodies for which dignified funerals are not available. In the case of live donations, Bodyworlds has a duty to participate in the medical care of needy donors. However, secrecy with regard to the source of cadavers seems to be the most troublesome aspect of Bodyworlds.

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.

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.

The story of the body and the story of the person: towards an ethics of representing human bodies and body-parts.

Western culture has a few traditions of representing the human body - among them mortuary art (gisants), the freak show, the culture of the relics, renaissance art and pre-modern and modern anatomy. A historical analysis in the spirit of Norbert Elias is offered with regard to body - person relationship in anatomy. Modern anatomy is characterized by separating the story of the person from the story of the body, a strategy that is incompatible with the bio-psycho-social paradigm of clinical medicine. The paper discusses different aspects of the above traditions and how they might bear on this conflict and on contemporary bioethics and bedside practice.

Re-inventing anatomy: the impact of plastination on how we see the human body.

Over the past 20 years the development of plastination has opened up new vistas for gross anatomy. In particular, it has led to a major expansion in the range of human anatomic specimens available for teaching and its potential value in research is increasingly being appreciated. More recently, it has burst into the public arena through what has become known as 'Anatomy Art,' as depicted in the von Hagens exhibition, Körperwelten (Bodyworlds). In this exhibition, the lifeless cadavers of the dissecting room have been transformed into standing, sitting, and jumping lifelike plastinated 'models' that demonstrate spinal cords, tumorous lungs, cirrhotic livers, joint prostheses, and sagittally sectioned whole bodies. Not surprisingly, the exhibition has raised considerable ethical debate about treating human cadavers in this way, an issue of particular relevance to anatomists. This article is an attempt to further this debate by considering the nature of plastinated human specimens, and the context within which they should be examined. The only rationale for displaying (plastinated) human material in the public domain is an educational one, with a basis in a museum ethos. The boundaries of this educational rationale are discussed, as are the opportunities and challenges presented by plastination to the anatomical community.