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A Tainted Classic
Anatomy Text Draws Criticism

By Rich McManus

On the Front Page...
A working group of intramural scientists has convened to decide the fate of an anatomy textbook -- originally published in 1943 and available in the NIH Library and National Library of Medicine -- written by a Nazi physician and, critics contend, based on data gleaned from Holocaust victims.

The two-volume Pernkopf Anatomy, Atlas of Topographic and Applied Human Anatomy by Dr. Eduard Pernkopf has been reprinted several times (the NIH Library has the 1964 and 1989 editions, translated in English from the original German) and has been recognized as a classic in the field. But during a lecture at the Holocaust Museum in Washington, D.C., last spring, two NIH physicians were outraged to learn of grim complicity with evil on the part of German doctors, including the renowned Pernkopf.

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Dr. Robert Nussenblatt, NEI scientific director, had never met Dr. Pablo Gejman, chief of NIMH's unit on molecular clinical investigation, Clinical Neurogenetics Branch, prior to the lecture, titled, "Hippocrates Betrayed: Medicine in the Third Reich." But afterward they were united in their revulsion over what other medical professionals, who too had once sworn to "do no harm," had committed in the name of science.

"I came back [from the lecture] saddened, horrified, and angry as the role of physicians became clarified," said Nussenblatt, who says he clings, albeit "naively," to the Hippocratic Oath. "It became clear from the information presented -- and my impression is that this is not questioned in any way -- that the Nazi mentality and 'solution' was very much a product of the medical philosophy of the time. It was a very sobering message for me."

Feeling a sense of betrayal on the part of physicians, Nussenblatt returned to NIH where he confided his emotions to Dr. Michael Gottesman, NIH deputy director for intramural research, who put him in touch with Gejman.

"Pablo was there and was equally angered," Nussenblatt recalls. "We've become good friends since then."

Drs. Robert Nussenblatt (l) and Pablo Gejman have become friends over the Pernkopf issue.

Gejman, a native of Argentina who spent 5 years in Israel, has joined Nussenblatt, Gottesman, and several other NIH scientists including Clinical Center director Dr. John Gallin, NIDDK scientific director Dr. Allen Spiegel, and new CC bioethicist Dr. Ezekiel Emanuel, on a working group that will try to decide what to do about the tainted texts. Opposed to book burnings and censorship, the group hopes to agree on a useful, educational way to expose the texts' past.

Gejman says the reigning medical philosophy of the era gave rise to atrocities: certain races were deemed healthy and fit and others ranked lower. Society apparently accepted as truth certain "scientific" findings about the relative value of the aged, the ill, and, eventually, certain cultures and religions.

"The elimination of the unfit was accepted," he said. "It was just a difference in scale from the elimination of the mentally ill, and children with genetic defects, to the Holocaust, which was the elimination of what was considered undesirable for the Nazis."

"By the 1930's, individuals considered unfit were murdered in Germany," adds Nussenblatt. "They were gassed and drugged. It was a simple maneuver to bring this sophisticated expertise to the Holocaust."

Physicians were deeply involved in these actions, he said; some were SS (German secret police) members.

"The trains that brought Jews to Auschwitz were met by a physician who decided who lived and who died, based on brief physical inspection," he continues. "A physician led the prison camp at Treblinka and oversaw the killing of Jews. Physicians did experiments on people deemed unfit."

Enter Eduard Pernkopf, an anatomist, embryologist -- and Nazi -- on the faculty of the University of Vienna. In 1938, when Hitler's troops invaded Austria, Pernkopf was made dean of the faculty and began getting rid of Jewish professors and others who wouldn't take a loyalty oath to Hitler. Gejman learned that 132 faculty members were thus purged, out of a total of 197 teachers.

In his first official speech in his new capacity, Pernkopf issued the following charge to his faculty in words that clearly predict, to Gejman, both euthanasia and eventual Holocaust: "To assume the medical care -- with all your professional skill -- of the body of the people which has been entrusted to you, not only in the positive sense of furthering the propagation of the fit, but also in the negative sense of eliminating the unfit and defective. The methods by which racial hygiene proceeds are well known to you: control of marriage, propagation of the genetically fit whose genetic, biologic constitution promises healthy descendants: discouragement of breeding by individuals who do not belong together properly, whose races clash: finally, the exclusion of the genetically inferior from future generations by sterilization and other means."

Pernkopf remained dean until 1943, during which time he completed his first atlas, then was promoted to president of the university until the war ended.

Piecing together evidence from many quarters, scholars argue that Pernkopf dissected the corpses of Nazi victims in order to explore human anatomy. Among the atlas drawings are faces that appear to be Semitic, dissections of circumcised men, and signatures of medical artists that incorporate both swastikas and SS symbols. Gejman found that these symbols continued to be published in the 1963-1964 English-language editions of the atlas.

"There are well-founded allegations that the Institute of Anatomy of the University of Vienna used corpses of executed persons for teaching purposes," said Gejman. "Some of these materials may still be in use at the university." He found further allegations that the bodies of murdered children were used in research at a Vienna hospital, though it isn't clearly proven that this occurred under Pernkopf's direction.

Gejman confronted the book's current publisher with his findings, but has been brushed off. "They allow that the author may be tainted, but the work itself is not tainted," he said.

Gejman doesn't disclaim the book's scientific worth: "A 1990 editorial in the New England Journal of Medicine described it as a classic in the field. It is a very well-known book for surgeons. It has some of the best work of medical illustration. Even in Israel you will find these books," he said.

But therein lies the ethical problem, says Nussenblatt. "Up to now, the book has had scientific value, but now we know that it is tainted. People suffered horribly and were executed due to their race or ideology. And for 50 years we've had people saying [the Holocaust] couldn't have happened. So what do you do with data that's tainted ethically? How do we somehow make it educational? We want to handle this in a positive way, to turn something that was terrible and sad into something positive. We don't want to burn these books."

Echoed Gejman, "After some debate among the physicians concerned with the problem, we decided that we don't want to remove the books or destroy them. But some pointers or explanation might be helpful. We need to decide how far to go. Should there be a Holocaust section of the library? I think it may be worthwhile for NIH to host a consensus development conference on these ethical issues."

Gejman says that tainted medical texts don't stop with Pernkopf; his own profession of mental health has skeletons in its closets.

"There are major problems in psychiatry," he said. "Many mentally ill people were killed. Psychiatry doesn't deal with its own history as it should."

Cautions Nussenblatt, however, "We don't want this to be a witch hunt."

Both men see in Pernkopf unsettling glimpses of current moral dilemmas.

"If we don't understand our past, we won't be able to set forth our future," Nussenblatt warned.

Uninterested in meting out punishment to those involved in wartime crimes, Nussenblatt prefers instead to end what he terms a "conspiracy of silence." Let the light of day shine on some of the still-living guilty parties and let humanity know these survivors for what they are. "The worst thing that can happen to them is to bring their deeds into the limelight," he said. "There are higher goals than revenge."

Nussenblatt observes that "science and medicine are amoral. Morals and ethics are brought by the people who do it." Science, when insufficiently challenged -- or too highly regarded -- by society, can be harmful, he said. "In the 1930's, social, class and racial distinctions were very strong and were assumed to have been proven scientifically. That's the constant battle of science -- to avoid being seen as unchallengeable authority."

It is still stunning to Nussenblatt that so many of the guilty parties from that era remain unremorseful. Their excuse? "They only did what they felt society asked them to do.

"We'll be facing some new challenges with the Human Genome Project," he predicted. "We'll be faced with some soul-searching questions in the future. But we have these soul-searching questions from the past that we haven't dealt with."

He said it's important for younger physicians to be aware of how their profession may be steered awry, "especially as those who witnessed it first-hand die off."

Pernkopf's book, while a classic, is no longer a unique work, said Nussenblatt. "There are very adequate substitutes," and the Visible Human Project at NLM is fast making old anatomy texts obsolete.

The two scientists presented the Pernkopf case to the NIH scientific directors at a meeting last June, and the working group has since assembled, and meets this month. While many colleagues who are aware of their extracurricular interests are supportive, some are skeptical, admits Gejman. "Some have told us to stop beating a dead horse."

The two are deeply aware of this issue's potential to derail their other professional commitments, not even to mention the sheer weight of utter sadness about the Holocaust. But the good that might emerge from such deep evil prompts them to seek positive closure.

Nussenblatt freely admits the group needs professional guidance. "It shouldn't be a personal vendetta -- that's not what we want," he said. "We have to raise ourselves above this garbage. And it shouldn't ever happen to somebody else."

Gejman says it's essential to deal with Pernkopf because society is ever on the verge of tumbling down slippery slopes. "In the 1920's, the idea of the elimination of the unfit became prominent among a few physicians in Germany. This was followed a few years afterward by the first formal decisions by the medical profession on who should live and who should die, and proceeded all the way to the Holocaust."

"These questions are even stronger now due to the power of science," said Nussenblatt. "Science can do very powerful good, but it can also do very powerful evil. The Holocaust is a glaring example of where scientific rationales were applied through pseudoscience carried out by immoral people."