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Squaring an anatomy atlas’ Nazi history with its potential to heal

Surgeons

Dr. Susan Mackinnon (front row, second from left), a nerve surgeon at the Washington University School of Medicine stands in the operating room with surgeons from around the world and the Pernkopf Atlas of Human Anatomy, sitting open on the table on the right, which Mackinnon used to diagnose pain in a patient's foot.

Alice, a member of a local Conservative synagogue, wanted to find the source of severe pain and numbness in her left arm.

Dr. Susan Mackinnon, one in a series of doctors who Alice saw for help earlier this year, diagnosed the injury through tests and offered to show Alice exactly where it was. 

But there was quite a caveat to the offer.

Mackinnon, a specialist in peripheral nerve surgery at the Washington University School of Medicine, explained that she could only do so through an atlas of anatomical paintings created by an Austrian anatomy professor who used the bodies of Jews and others executed by Nazis.

Did Alice, an active volunteer in the Jewish community, still want to see it?

“When you first learn about its history and its origins, you just take a second and pause because it’s just so unfathomable, the suffering of these people,” said Alice, who did not want her real name used. 

She agreed because it would help her understand the injury and because “there is nothing that is going to bring back all the people who suffered at the hands of the Nazis.”

Mackinnon, who is not Jewish, has recently been leading efforts to develop an ethical approach to using the seven-volume “Pernkopf Anatomy: Atlas of Topographic and Applied Human Anatomy.”

“I want people around the world to do the best kind of nerve surgery that they can do, and I cannot do the best I can, even after 30-some years of practice, without from time-to-time using that atlas,” said Mackinnon, chief of the Division of Plastic and Reconstructive Surgery at Washington University and an internationally-recognized expert in nerve surgery.

Mackinnon, along with three other physicians, an anatomist, a medical illustrator and an Orthodox rabbi who has analyzed the atlas, spoke last month at the University of Toronto during a Holocaust education week event titled, “The Vienna Protocol: Medicine’s Confrontation With Continuing Legacies of Its Nazi Past.”

Around the same time, the group of speakerswere among those also trying to convince the owner of the original anatomical paintings used in the atlas to donate them for an exhibit at a medical museum at the University of Vienna, where they were first created.

“I think people should want to talk about this and not forget it,” Mackinnon said.

Anatomy Illustrations

An illustration from the Pernkopf Atlas of Human Anatomy (left) and an illustration (right) of the same part of the body from a similar atlas without as much detail

Disclosing the atlas’ origins

Mackinnon first discovered the atlas, which is far more detailed than other comparable works, in 1982. At that point, it was still praised for its extremely accurate illustrations. In 1990, The New England Journal of Medicine described it as an “outstanding book of great value to anatomists and surgeons.”

For example, Mackinnon said, in most anatomical texts, the accessory nerve looks like a straight line “but it’s actually very plexiform and when you see that nerve (in the Pernkopf atlas) it looks like it’s impossible not to injure it. But if you look in (other atlases) you think, ‘How could they possibly injure it?”

Still, that useful guide was created by Pernkopf and artists who were avid Nazis, according to a 1988 study from Purdue University. A University of Vienna investigation determined in 1998 that Pernkopf’s anatomy department received bodies of executed prisoners from the Gestapo and from Vienna’s criminal court.

Around 1996, an oral surgeon at Columbia University, who was Jewish, tried to publicize the history and eventually stopped using the atlas, according to The New York Times

In 2015, Dr. Sabine Hildebrandt, a pediatrics professor at Harvard Medical School came to Washington University to give a lecture on Yom HaShoah about “ethical transgressions and anatomical sciences in the Third Reich.” 

During the visit, Mackinnon and other WU faculty asked Hildebrandt whether she thought it was ethical for doctors to use the atlas. 

Mackinnon and Andrew Yee, a surgical education specialist at the medical school, were developing a libraryof educational videos on nerve surgery containing surgical procedures that were heavily influenced by the atlas, according to Mackinnon and Yee. The videos had been viewed more than 4 million times, including in war-torn areas.

Hildebrandt told the doctors that the atlas could be used for good but only by also disclosing its history and consulting with relevant experts. (Mackinnon discloses the atlas’ history to all patients in her clinic and gets their consent before she shows it to them.) 

Mackinnon and Yee conducted a survey of surgeons who were using the video education platform and learned that only half were aware of the atlas’origins and that 13 percent of those surgeons were using it in surgery. The WU faculty members then presented the surgeons with a proposal regarding disclosure, bioethics, remembrance and Jewish law considerations around the book. Seventy-six percent then said they would be comfortable using it. 

Around the same time,Mackinnon and Yeereached out to Elsevier, the publishing companythat held the atlas copyright, about its use of the images for medical and educational purposes. The company responded by stating that it would no longer publish the book or allow licensing of it because allegations “arose that the bodies used for dissection to draw the images came from Holocaust victims.” 

And, proving that advanced surgeons are thorough, Mackinnon and Yee contacted Rabbi Joseph Polak, an expert in Jewish medical ethics at Boston University School of Public Health, with a question about a patient experiencing excruciating pain in her knee. The patient told Mackinnon that if she couldn’t find and treat the source of the pain, she wanted her leg amputated. 

Polak told Mackinnon that she was allowed to use the atlas but that “your students who are watching the surgery, your associates who are watching, the woman herself and anybody who is at all involved in this, needs to know what the Pernkopf atlas was.”

Mackinnon was able to diagnose and treat the nerve pain.

Polak reflected on Mackinnon’s call during the recent lecture at the University of Toronto, saying that “when the Nazis started ordering corpses of a certain size and certain shape, that’s called murder a la carte and was a new low in medical ethics and human ethics.”

“When Susan Mackinnon called me and said, ‘May I use this atlas?’ she turned around that direction into evil and started up-righting a cause that had dropped to its lowest level,” Polak said. “She started returning the course of medical history to a more proper direction.”

Hopes to replace the atlas in the future

Mackinnon, who grew up in Canada, said that she has long been interested in history. Her parents would drive her around “the countryside, looking at monuments, and then we would be talking about the people in these monuments.”

When she shows the atlas to patients, she points out that there is no fat on the bodies because “all the patients were starved and emaciated.”

She also avoids saying the name of the creator of the atlas and instead refers to it as the “atlas of the Holocaust” or “atlas of the Shoah” and would like to see it reprinted that way.

But given its dark history, why not just leave it in a museum and create a new one?

Yee said it took more than two decades to complete the atlas.  Starting a new one would also take that amount of time and be a multimillion-dollar project. 

“Medical schools have better ways to budget those type of dollars,” he said. “We hope that this level of awareness will help reach that point where somebody’s body of work will replace this book.”

A spokesperson for Elsevier stated in an email to the Jewish Light last week that the publisher would donate the paintings to the Josephinum Medical Museum at the University of Vienna.

The group advocating for the transfer declined to comment on the Elsevier decision because they said it was not finalized.

Mackinnon’s patient Alice is on nerve pain medication and waiting to see whether the injury will heal or require surgery.

In the meantime, Mackinnon, who is stepping down as chief of plastic and reconstructive surgery, will continue to educate people about the atlas. 

“I’m interested in teaching surgeons that want to know what I do,” she said. “I’m not interested in converting nonbelievers of what I do to anything. If they look after their nerve patients and are happy with their recipe, I don’t want to change it. But if there are surgeons around the world who want to know how I do anything, I am compelled to give that away as best as I possibly can.”