Letter to the Editor: Nazi Medicine—Part 2: The Downfall of a Profession and Pernkopf's Anatomy Atlas

To the Editor, We appreciate Dr. Leopold’s decision [5] to publish Dr. Erdem Bagatur’s work [1, 2] and would like to comment specifically on several points in Dr. Bagatur’s essay on Pernkopf's atlas [2]. Dr. Bagatur describes the Pernkopf atlas as a “rare example of genuine scientific work by Nazi Physicians,” quoting sources from 1998 and 2006 [2]. However, “genuine scientific work by Nazi physicians” was not as rare as has often been assumed [8]. Some Nazi medical experiments, such as those on sulfonamides [10], and Nazi research on cancer [9], were based on scientific rationales and followed key elements of the scientific method (although the conduct of the sulfonamide experiments was both abhorrent and criminal). Indeed, an important point to be made is that strict adherence to the scientific method alone does not preclude unethical or even immoral research practice. Productive, but unethical research was also performed by Nazi anatomists [3], who used a great number of executed Nazi victims for their research and subsequent publications [11, 12]. These became part of the general canon of anatomical knowledge after the war and continue to be used. The Pernkopf atlas is one example of such work with unethical origins, resulting in modern ethical challenges in the operating room [13, 14]. For these reasons, despite the glaring moral failings of the Nazi physicians who conducted the original research, this topic remains as pressing today as it ever was, both to bioethicists and practicing surgeons. Dr. Bagatur voices surprise over the documented continued use of the Pernkopf atlas by nerve surgeons [13], who often treat patients with neuropathic pain with the goal of returning them to life with functioning extremities. We would not describe ourselves as “defenders” of the atlas, but rather as proponents of a carefully considered and ethically grounded decision to permit the use of the atlas in very specific situations. In fact, one author (SEM) found herself repeatedly in an ethical dilemma—she needed information from certain images of the Pernkopf atlas to successfully navigate surgery in complex cases [14]. Cognizant about the Nazi background of the atlas, two of the authors (AY and SEM) initiated a discussion with medical historians and religious authorities as to the permissible use of the atlas [4], and thereby contributed to the creation of the Vienna Protocol [6], a responsum (formal Jewish legal and ethical opinion) by Rabbi Joseph Polak, a Holocaust survivor and Chief Justice of the Massachusetts Rabbinical Court. After studying all relevant traditional sources, Rabbi Polak concluded that the use of the Pernkopf atlas may be permitted in specific situations under the Jewish principle of Pikuach Nefesh, the saving of human life, but only after case-specific rabbinical assessment and under the condition that the memory of the victims is honored [7].

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