The Journal of biocommunication最新文献

Frequently misunderstood because of the history of the time in which it was produced, Eduard Pernkopf's Topographische Anatomie des Menschen nevertheless represents the pinnacle of color anatomic illustration. The more than 800 magnificent watercolor paintings of human anatomy found in Pernkopf's atlas occupied a number of Viennese artists for three decades. This article closely examines the work and its creators.

(Reprinted with permission from NEUROSURGERY, Volume 84, Number 2, February 2019).

The Pernkopf anatomical atlas has contributed significantly to the specialty of nerve surgery through its infiltration in surgical training and the development of novel procedures due to the accurate depiction of the nervous system. Until the recent advancements of the Pernkopf controversy, nerve surgeons have struggled with the ethical dilemma presented with its use in surgery and clinical practice. In this article, we explore a personal story and reflection by an individual nerve surgeon, their contribution to the advancement of the Pernkopf controversy, and how different professional domains (surgery, anatomy, ethics, religion, and education) were able to collaborate to address the historical crimes against humanity and issues in the anatomical sciences. This required a structured approach to address this ethical dilemma in surgery, which included (1) an assessment of the use of the Pernkopf atlas in specific surgical specialties (nerve surgery and oral and maxillofacial surgery) and (2) the development of a graduated ethical framework with a religious framework (the Vienna Protocol), if the Pernkopf atlas was to be used in surgery. These studies are reviewed in the context of evolving paradigms in nerve surgery (nerve repair, grafting, and transfers) and influence of anatomy in the advancement of this surgical specialty.

The high fidelity anatomical structural detail seen in the Pernkopf atlas remains unmatched in other references, including surgical anatomy atlases. An example of serial dissection illustrations are examined herein, in relation to an anatomically based clinical question. The question is about radiofrequency nerve ablation, an image-guided procedure that provides a non-opioid alternative to treat joint pain. To perform these image-guided procedures effectively, the location and course of the nerve(s) being targeted is very important. Although the patient had good pain relief, the clinician was concerned about the patient's loss of sensation around the anus following an ablation procedure of the nerves innervating the sacroiliac joint, and asked for more information about the clunial nerves and their relevance to this procedure. The anatomical illustrations in the Pernkopf atlas are highly detailed and drawn from serially dissected specimens from the skin superficially to the level of the origin of the nerves from the vertebral column deeply. Tracing the clunial nerves through five serial illustrations provided the necessary anatomical insight required to answer this clinical question for development of the ablation procedure. This atlas could play a significant role in educating future clinicians and surgeons and provide answers to anatomically related clinical quandaries. However, the atlas must always be used by first acknowledging its origins and history.

(Reprinted with permission from Special Symposium Hosted by Yad Vashem: May 14, 2017).

Knowledge of the dark history and inherent ethical dilemmas of Pernkopf's atlas is essential to individual decisions on use. Seventy-five years after the Holocaust, the legacy of Pernkopf's Atlas of Topographical and Applied Human Anatomy continues to unfold. Informed use of the atlas needs to be integrated in academia and in practice. This paper advocates for the adoption of The Vienna Protocol and improving informed use of the atlas by: (1) updating and inserting an information letter in as many volumes as possible, so that the history can be known before use; (2) conducting and publishing a research study within the medical art community, to examine knowledge of the history of the atlas and elevate awareness; and (3) creating a museum archive and permanent exhibition of the original anatomical illustrations, to document historical facts, disseminate visual evidence, and illuminate embedded controversies. Moving towards informed use, in these ways, provides opportunities for continued ethical discourse, personal reflection and future Holocaust education. Through informed use we memorialize and pay tribute to the Nazi victims portrayed in the atlas.

An historian of World War II Germany was asked, about whether there was a single ideological notion that proved to be the most influential in allowing the horrific evils of the Holocaust to take place. It is the very idea, derived from the Romantics, he wrote, that artists are entitled to live outside of morality. Hitler and others unquestionably saw themselves in this way. With this realization we have arrived at the reductio ad absurdum of this Romantic ethic: the Artist as Murderer. And it is because we believe that like artists, physicians occupy a higher sphere, that we have, in Holocaust times, the transformation of the physician, like the artist, into the murderer. Like the artist, who murders but does not do so with his own hand, the physician supervises executions and unspeakable experiments. Anatomists buttressed their collections at a range of German and Austrian universities, by placing orders from among the executed and about-to-be executed. It is this that I have in mind when I speak of "murder-a-la-carte." Pernkopf was one of these anatomists. Through the atlas he immortalizes the victims. Years later, a surgeon asks about the atlas and protocols for continued use, to benefit patients and educate, are created. The surgeon may well be rescuing the medical profession itself from its own historical sins of presumed unaccountability, of returning it to a human place where the dignity of the patient remains inviolable, and where the victims of medically inspired evil gaze out at us from the pages of the atlas, both as a blessing and as a warning.