Should a surgeon use a medical reference book with anatomical illustrations that are derived from Nazi victims? That’s the ethical quandary a team that included BU’s Michael A. Grodin and Rabbi Joseph A. Polak (Hon.’95) sought to answer in an article in the May 29 issue of the journal Surgery.
The medical text in question is the Pernkopf Topographical Anatomy of Man, an atlas created by Viennese medical illustrators who were Nazis or Nazi sympathizers. No longer in publication after an investigation in the 1990s revealed that the bodies depicted in it were victims of Nazi atrocities, the atlas still continues to be used by some surgeons who have found its highly detailed and accurate renderings helpful in treating patients.
But should they use it? It’s a conundrum that prompted surgeons at Washington University in St. Louis to ask Grodin, a School of Public Health professor of health law, ethics, and human rights, and Polak, BU Hillel House rabbi emeritus and an SPH adjunct professor of health law, ethics, and human rights, to collaborate on an article about it. Grodin, an internationally recognized authority on medicine during the Holocaust, says that apart from the revelations of the Nuremberg Doctors Trial, there has been very little formal consideration of the role of medicine in the crimes of the Third Reich. The Pernkopf atlas offers lessons far beyond its pages to doctors, surgeons, and contemporary researchers who must think about the past as they move forward.
“It’s a teachable moment,” says Grodin, who is also a School of Medicine professor of psychiatry and of family medicine.
BU Today: How did you learn about the Pernkopf atlas?
Grodin: I knew about this from colleagues around the world who were working on Nazi medicine and human experimentation. We noticed the signatures of the illustrators included an SS insignia and swastikas, showing the leanings of the illustrators.
In later editions, the SS insignia and swastikas were airbrushed out. But actually, Boston University School of Medicine has a copy of the early Pernkopf atlas, which still has the original SS insignia and swastikas. It was in our own BU medical school library. I found it on the open shelves.
What did you do?
I told the library that they needed to take it off the shelves and to protect it, because it’s a very rare document.
There needs to be a plate identifying the origins and circumstances of the creation of the atlas and its connections to the Third Reich placed on the front cover, and then, minimally, we need to say that these images were probably acquired through immoral and illegal means and that the anatomy text was put together from the collection of murdered cadavers.
Who were the subjects pictured in the Pernkopf drawings?
We don’t know the exact source of all the bodies, but we do know that they were murdered prisoners. It was part of our project to attempt to identify and to notify the families as a way to respect and dignify these human beings that were dehumanized and murdered. We were unsuccessful in this quest.
When did you begin studying doctors and the Holocaust?
I’ve been involved for 30 years conducting research on the Holocaust. I come from generations of rabbis and Jewish educators. When I attended the Albert Einstein College of Medicine, in Bronx, N.Y., I encountered many Holocaust survivors. I became very interested in resiliency, and why some survivors did better than others, and focused on the positive aspects of care. I was struck that each survivor’s story was unique. Their experiences included concentration camps, work camps, and death camps.
In the 1980s, I became involved in a project on the Nuremberg trials and the Nuremberg Code. It came to light that there were physicians who were involved in all aspects of the Holocaust; racial hygiene theories were necessary to legitimize and medicalize the Nazi ideology and the Nazis needed the doctors to legitimize the racial hygiene program. That led to sterilizations, and sterilizations led to the child euthanasia program, which in turn led to the adult euthanasia program. Ultimately the doctors and nurses who were involved in the gas chambers in mental hospitals moved to the death camps.
So I became involved in studying the human experimentation and other research carried out by the Nazi doctors.
Is it ethical to use Pernkopf or the data from Nazi research?
That raises a series of questions. Should the survivors, or families, of these victims—the subjects of the atlas renditions and the human experimentation research done by the Nazi doctors—have a right to decide what should be done with the anatomy text and the research data?
If you ask people like the Mengele twins, the research subjects of Dr. Mengele’s twin studies at Auschwitz concentration camp, who are now in their 80s and 90s, whether this data should be used for research, just like the questions about the Pernkopf anatomy atlas, what’s the answer?
The positions of survivors and their families include a broad spectrum of opinion. Some say that data and the anatomy text should never be used. Others say that it can be used to honor the people who died. But everybody agrees, you can’t just use the data or the anatomy text without being cognizant of the origins of this information. All would agree on that.
Rabbi Polak and I looked at it from a Jewish legal perspective. And that’s where the discussion of saving a life comes in. You cannot take one life to save another. Life is sacred and created in God’s image. With respect to the Pernkopf atlas, if it can be used to save a life, that takes precedence over almost anything.
So in essence you’re saying you can derive good from evil?
You can. And perhaps it is even required if you can save a life.
Taking a step back, how did scientists and doctors in German society justify the use of murder victims’ bodies to further science?
Much of the research that was done was military-related. The Germans were concerned about the effects of high altitude on their pilots. The Nazis built specially designed chambers, where they would suck out the oxygen and mimic high altitudes. They placed concentration camp victims in these chambers, with the end result being their deaths. I saw the actual medical records when I was at Dachau [concentration camp] that described the results of these high-altitude experiments.
There was also earlier eugenic research, which continued during World War II. These studies looked for methods to increase Aryan stock while eliminating “inferior” races. One of the reasons Josef Mengele studied twins was to see if they increased the birth rate of Aryan babies. Interestingly enough, at the Nuremberg Doctors Trial, the Nazis, in their defense, pointed out that racial hygiene and eugenic sterilization was practiced in the United States before the Nazis came to power.
What were those influences in the United States?
There were sterilization laws passed in 1907 in Indiana. And there were sterilizations done in the United States of people who were “habitual criminals” or “feeble-minded.” In 1927 the US Supreme Court ruled that a statute permitting compulsory sterilization of the “unfit” was constitutional. Justice Oliver Wendell Holmes, in his written opinion on this case, said that “three generations of imbeciles was enough” in justifying the sterilization.
That was pointed out by doctors at the Nuremberg trials. A German doctor said, “Where do you think the eugenic ideas were [from]?”
How did so many doctors and medical practitioners lose their humanity during the Holocaust?
That’s the profound question. But I think it starts by going down the path of seeing people as less than human, as objects, as instruments. For example, in the United States, in the Tuskegee syphilis study after the Holocaust, poor black sharecroppers were followed, but never treated, for syphilis. Researchers withheld penicillin from them. There are other US studies where children were infected with live hepatitis virus to study a vaccine (1955-1970); they injected live cancer cells into poor, debilitated elderly people in Brooklyn without their knowledge in 1962.
How would you like to see physicians and educators treat the Pernkopf?
One way is to educate, to publish this article like we did in Surgery and bring this to people’s awareness, and let them carry on the conversation. I think it’s a teachable moment. The fact that the atlas might be used is an opportunity to discuss the ethical issues and to remember and honor the victims.