This is a story about death.

From 1938 to 1945, thousands  of Austrians were executed. Some were political prisoners,  others were petty criminals, and still more were disabled children.

Their bodies were given to medical schools, where doctors and students pored over  the inner workings of their every organ. This is a story about ambition. Around the same time, a team of  Nazi artists and dissectors were working on one of the most comprehensive  anatomy textbooks of all time, using some of those same bodies.

It’s called the Pernkopf Atlas. And its illustrations were so detailed  that some surgeons consider them the best that have ever been  created, and still use them today. This is a story about medicine.

The anatomical work of the Pernkopf  team was built on a foundation, centuries old, crafted brick by brick  with exploitation of the vulnerable. This rotten foundation stretches  as far back as the 1200s, when anatomists revived an old practice that had previously long been seen  as gauche, base, unclean. The careful practice of dissecting  human cadavers to study them, to break apart the human form in order to  learn how to piece it back together again.

The art of cutting open one  person in order to heal another. And yet… those being cut open  almost never had a choice. This is a story about power.

It’s a story about anatomy, and  humanity, and what we do at a crossroads. The lengths to which we have gone  to understand our own bodies, and the things that we have  sacrificed along the way. Most of all, it's a story about a book.

A book that may be the most heinous  volume in the history of anatomy, but is also one of the  field’s crowning achievements. A book born of brutality and exploitation, that now has the power to heal and make  whole. And in its pages, a question: What do we do with the fruits  of such poisonous trees? [♪ INTRO] Content warning: We’re going to discuss  a lot of difficult topics in this video, and to do so, we will be showing  illustrations of human remains, including some images from the Pernkopf Atlas.

There will be an on-screen  warning ahead of these images, and we will include time codes  to skip in the video description. The copies of the Perkopf Atlas  that we obtained are on our set but will remain closed. All anatomical props used  in this video are replicas.

It’s been said that if Eduard Pernkopf  had one love, it was medicine. And if he had a second  love, it was the Nazi Party. Pernkopf was born in Austria  in 1888, the son of a doctor.

When his father died, Eduard  took up the family trade, receiving his medical degree in 1912. Pernkopf was a hardcore German  nationalist, even in his university days. He joined The Student Academic  Fraternity of Germany, a nationalistic political organization  that favored a unified German state.

So he really hit the ground running on  the hard nationalist ideology thing. He started teaching anatomy  immediately after graduation, stopping briefly to serve as a  field medic during World War 1. And he was a big shot on campus well before he created one of the most influential  anatomy textbooks of all time.

He was promoted to associate professor  at the University of Vienna in 1926, and just seven years later, he was  named director of the Anatomy Institute. In that same year, he joined the  National Socialist German Workers' Party, better known by their other name: the Nazis. Then in 1934, he joined the  Sturmabteilung, aka the Brown Coats, the paramilitary wing of the Nazi party.

Which, by the way, was still  illegal in Austria at the time. Not only did he subscribe to some  of the worst ideas in history… he was an early adopter. His hard-right allegiances didn’t turn out  to be a problem for his career, though.

Mere days after Hitler and the  Nazis invaded Austria in 1938, Pernkopf became the Dean of the medical school. Once he had that power, he did  what any other fascist would do: He forced all faculty to declare loyalty  to Hitler and state on the record whether they were Aryan or non-Aryan. Married faculty needed their  spouses to do the same.

Anyone who refused was fired, and  a new law banned Jewish people or those married to Jewish people  from any civil service jobs, forcing them into early retirement. Pernkopf’s impassioned speeches,  adherence to Nazi regulations, and all-out zeal for facism  were probably major reasons that he was eventually named Dean  of the entire university in 1943. But all the while, as his early career progressed, he was also working on a manual for his  students, to aid them in their dissections.

And it was this manual that would grow and become the book we’re discussing today. The book’s full title in English  is The Atlas of Topographical and Applied Human Anatomy, but most  simply call it the Pernkopf Atlas. It’s a massive compendium of  anatomical drawings so finely detailed that a recent survey of nerve  surgeons found that 59 percent of them were aware of it and 13 percent currently use it, though there’s been decades of debate  over whether that’s morally acceptable.

But we’re getting ahead of ourselves. After all, Pernkopf wasn’t the first to use dubious means to try to understand the human body. Just like the story of the Pernkopf Atlas, the history of anatomy is  a tale of power and abuse, all the way back to the very beginning.

To practice medicine, we need  to understand the human body. To understand the human body,  we need to look inside it. And to do that… we need bodies.

Some of the oldest and most  iconic historical records of human dissection go back to the Egyptians. Their famed mummy-making mortuary  practices required enough knowledge of the body to disassemble it, preserve it,  and prepare the deceased for the afterlife. Skilled artisans would take the  body, remove pieces bit by bit, and carefully preserve them for the next world.

To do so required some  knowledge of what was in there, but it was largely divorced from the reality of what each body part really did  or even where it was precisely. How much knowledge they had is hard to say, because we don’t find many written  records from the embalmers’ perspectives. And there’s basically nothing written down about the surgical parts of mummification.

Some researchers think that embalming  was too taboo to talk about, or that the families tasked with caring  for the dead had trade secrets to protect. But either way, we can’t really  know what the embalmers knew, only what they did with human remains. Also, the corpses on their tables  were people who’d had the wealth and status to earn the fancy burials.

Cutting them open was an act of respect, reverence even, for the person being dissected. This… may have been the  last time that was the case. From here on in our story, when  humans are dissecting other humans, there’s not going to be a lot of care or  compassion for the person on the table.

To get into all the gory details  about Pernkopf and beyond, we spoke to Sabine Hildebrandt,  a professor of anatomy at Harvard Medical School. And to tell the story, she takes it back  thousands of years to ancient Greece. If we're talking about the first  scholarly explorations in anatomy, we probably have to look at the  Alexandrian times, 300 before Common Era.

And there we have the first governments  that allowed the use of human bodies. There's always been a tension  in terms of scholars wanting to gain anatomical knowledge in  societies that would allow or disallow the use of human  bodies for such knowledge gain. And usually this permission by  society was given through governments.

And so in Alexandria, we  see that for the first time, where there was a government  that allowed anatomists to use human bodies for dissection. So the ancient Greeks were among the  first to investigate human anatomy in order to treat other, living people’s ailments, at least according to the records we have today. The first anatomist confirmed to have  used human cadavers for dissection and study was Herophilus, who found  that the brain was the epicenter of our intelligence, not the  heart as Aristotle claimed.

He was also accused of dissecting criminals while they were still alive,  so, mixed legacy there. The fact that the subjects of these  alleged live dissections were criminals speaks to the tension that  Hildebrandt was talking about, which is going to carry all the  way through to the present day. As laws changed around whose bodies  could be used for scientific progress, well… they were rarely putting  powerful people on the table – metaphorically or literally.

Historically disenfranchised  populations like the poor and criminals were usually the targets, and defining what makes someone a criminal can be pretty flexible. But it wasn’t always considered  cool to dissect humans, even after the Greeks had done it first. For instance in Ancient Rome, human  dissection was completely illegal, so any knowledge of anatomy  came from animal studies and what could be learned from  treating injured gladiators.

The earliest surviving  anatomical text comes from China. The Mawangdui scripts, which  date to some time before 160 BCE, include a diagram of an artery  stretching down a standing figure’s arm, and are thought to be the  scientific basis that would give rise to some traditional  practices like acupuncture. Meanwhile, the anatomists of  the Islamic Golden Age made their own anatomical and medical discoveries, but there’s debate among  modern scholars as to whether they did so by dissecting any humans as well.

Some have argued that dissection would  have been forbidden by Islamic law, but others disagree, saying that there’s no clear evidence of whether those laws existed. It’s also been proposed that if the  Islamic scholars were using cadavers, they were treating them with more  respect than their European counterparts. While we’re going to focus mostly  on the European tradition today, we absolutely want to recognize that  the Islamic and Chinese scholars were doing really important work.

Islamic scholars like Ibn Sina were  a big deal for European medicine. On the other hand, the Mawangdui  scripts weren’t influencing early European medical thought. They were only discovered  during an excavation in 1973, so literally nobody knew about them  until those archaeologists dug them up.

Since Pernkopf exists in the  context of European research, we’ll stick to the social and  historical forces that shaped that. This is also where I want to point out a shift, one that we’ll see persist  through to the present day. When the body becomes a tool for knowledge, we care a bit less about  where that tool came from, or how it reached the dissector’s table.

Now, over the centuries, societies had  varying ideas about just how ethical it would be to dissect people, so  the progress of anatomical research kinda happened in fits and starts. We’re going to fast forward a few hundred years and get to when human anatomy  comes into vogue, and stays there. By the 13th century CE, the  University of Bologna in Italy had expanded their coursework to include medicine, which also likely meant they conducted  post-mortems on the deceased.

Enter: Mondino de Luzzi,  a physician and professor. de Luzzi was the first person known to  incorporate dissections of human remains into the curriculum of a medical  school, and he conducted them in public. His first, which was carried out in 1315, was likely done on the body of a woman who’d been charged with an  unknown crime, and executed. According to one source, de Luzzi was  allowed to select the means of execution. He wanted to study her anatomy, after all, so would need to inform the executioner  what structures to preserve. de Luzzi also wrote what some  consider the first textbook on dissections, Anathomia corporis humani, which was used in medical  schools for more than 250 years.

At his public dissections, which  were as much spectacle as seminar, he sat above the dissectors, reading aloud from his manual or some other anatomy text. But while Anathomia was used as a  primary text for students for centuries, it did not include any illustrations. Various editions over the centuries  contained mostly artistic renderings of what a dissection party looked like, but with  little regard to what the anatomy showed.

The earliest collection of modern  anatomical drawings is likely De humani corporis fabrica, created by  the Flemish physician Vesalius in 1543. Where de Luzzi’s Anathomia was primarily text, with the engravings added in  the reprinting years later, Vesalius created visual depictions of  the inner workings of the human body, with the cadavers often posed in lifelike stances. And pretty much all of these  bodies were straight-up stolen.

He was known to brag about heists for cadavers, gleefully recounting the tale of  sneaking a woman’s body out of its tomb and taking it to the dissection hall. When a monk reported her body  missing, Vesalius and his students removed the woman’s skin, so  she wouldn’t be recognized. Furthermore, all of his dissections  were open to the public, and have been described as a form of theatre, with Vesalius taking on a role  of both anatomist and performer.

If the dissections were to be public,  they ought to be entertaining, after all. And it’s around this time that anatomy became a field of study not just for  doctors, but for artists, too. Renaissance artists wanted to study  human anatomy to better their art, and conducted illicit dissections  of criminal bodies to do so.

It’s likely that da Vinci and Michelangelo  studied the human form from cadavers, which helped them render  it in more lifelike detail. Plus, with the printing press,  everything we learned about human anatomy could be spread around the world, in as  vivid detail as the writers could produce. Anatomists now needed to be skilled  at dissection, description, and art.

As our understanding of medicine grew, it became more and more important  for doctors to study human anatomy. And like I said, to do that, you need bodies. So as we head from the 17th century onwards, there’s more and more pressure  on the supply chain of cadavers.

Anatomy and anatomical knowledge  gain always lives in this tension, as I said before, and anatomists always push for more bodies for their  anatomical knowledge gain. And so we see in the 16th, 17th century,  then laws emerging throughout Europe at the time, and also  starting in the United States, that the anatomists were allowed  through laws to use bodies of the impoverished or so-called unclaimed bodies, bodies of persons who died in  public institutions and were not claimed for a burial by their families. So we get the very first laws of such  a kind in the 16th, 17th centuries.

There was always the use  of bodies of the executed. However, that was never enough. A big part of this tension comes from  the attitudes about dissection itself.

It was seen as so repulsive, so debasing, that many anatomists longed for a better solution. Some even turned to anatomical models made of wax, crafted to be interactive,  dissectable, and also works of art. These models primarily took the form of women.

Always beautiful, and often pregnant. And yet even with the creation  of these anatomical models, the need for real, once-living bodies remained. It was exceptionally rare to find someone who’d be willing to let their body  get cut open after they died.

So…. the dissectors didn’t bother  to look for anybody willing. Institutions that wanted to procure bodies targeted two main groups:  poor people, and criminals. When people died in poorhouses  or their bodies were unclaimed, anatomists were permitted to  use their bodies for dissection.

And the same was true of those  charged with capital offences. With these supplies limited, there weren’t enough bodies to satisfy anatomists’ hungry minds. To be clear, this wasn’t just a problem because the anatomists would be bored or something.

We still knew so little about  how the human body worked, and every generation of doctors  was making bigger discoveries, learning things that moved  the field of medicine forward. These doctors had to know how bodies worked so they could, you know, be doctors. French doctor Jean Louis Petit developed  a version of the tourniquet in 1718, and later, made innovations in the  surgical treatment of breast cancer.

He knew to amputate the affected breast  and the swollen lymph nodes around it, to prevent the cancer’s spread. And he couldn’t have known to  do that if previous anatomists had never discovered what lymph  nodes were, and where they were. But every discovery needs an educated doctor, and to learn, medical students needed to cut.

The English government attempted to solve  this problem with the 1752 Murder Act, which amended the sentence for a murder conviction to be death by hanging, followed by dissection. This was meant to aid the anatomists, and to deter crime, since nobody wanted  their remains to be so cruelly cut open. One of the people put to death  under the act was Edith Morrey.

On August the 21st, 1812, in the Shire  Hall of Chester Castle in England, Edith was tried and convicted  of murdering her husband, though her lover was the one who held the knife. Both she and her lover were put to  death, and then, cut open for study. Their hangings, and their  dissections, were open to the public.

This was separated into two different cuttings. First came the anatomization, in which the coroner would cut the chest open to  verify that the person was dead. Seems like that would have  been pretty obvious, but okay.

They checked that the heart, lungs, and  brain were all no longer functioning. Only then did the dissection begin. This is where Edith Morrey’s  story began, and ended.

Although, after she was sentenced, Edith’s death had been delayed by a few months: She was pregnant, and so her punishment  was delayed until her baby was born. Her children were then left motherless, and all but the infant were  likely sent to the poorhouses. More unnamed victims of the Murder Act.

Over the eighty years that  the law was on the books, 1,166 people were sentenced  to die and be dissected. This still wasn’t enough to meet the demands from both anatomists and medical students, since dissection was becoming more  integral to their education, too. So to supply enough corpses,  bodies were stolen from graveyards.

Time after time, the remains used in  the pursuit of anatomical knowledge were of those who were societally disenfranchised. Their bodies were not their own. In Oxford, it was reported that the loved  ones of those executed would sometimes fight the body dealers to try to  preserve their family members’ remains.

And I wish I could say the worst was over,  but an equally ugly law was on the way. The Anatomy Act of 1832 allowed poor  houses to sell the unclaimed bodies of the poor to anatomists, to recoup the  financial losses of caring for these people. Not that that “care” was very, uhh, good.

The punishment for poverty would last  for decades, in some cases, centuries. Whether by poverty or by law, these  people’s agency in the treatment of their remains was robbed from them. Even worse, some of the remains of  people dissected under these laws are on display in museums today, still witnessed daily by members of  the public hundreds of years later.

How might these people have felt about their fate? Could the powerful people who created this system have anticipated that the  punishment would last this long? Would they even care?

When Eduard Pernkopf became a professor in 1926, he didn’t set out to create one of the most infamous books of anatomy the world had ever seen. His Atlas had much humbler beginnings. The book started as a manual for his  students to use in their dissections.

It was largely instructional, with some sketches and figures  to demonstrate techniques. But the manual became incredibly  popular among the medical community, even outside of his own students. So popular, that a publishing  house in Vienna called Urban & Schwarzenberg heard about it.

In 1933, they offered  Pernkopf a contract to produce a three-volume anatomy atlas  based on his dissection manual, and this project would consume  him for the rest of his life. The first volume of the  atlas was published in 1937, before Austria was annexed to Germany. Volumes two and three came out in 1941 and 1952, and the final volume was published in two  parts in 1960, after Pernkopf’s death.

Pernkopf was a skilled anatomist and  dissector, but he wasn’t an artist. So, in the creation of this manual of anatomy, he hired a team of illustrators to  render his dissections in paint and ink. The first to come on board was Erich Lepier, who was the only member of the illustrative  team not to have formal training in art.

He soon became the de facto  leader of the illustration team. The atlas took over thirty years to complete, so the full roster of illustrators  wasn’t the same from start to end. But the most prolific members of  the illustration team were Lepier, Ludwig Schrott, Karl Endtresser, and Franz Batke.

These artists were true masters of their craft, managing to render lifelike details of  the human body in glowing watercolors. For instance, Lepier used many techniques similar to those of the Dutch Golden Age painters, and even treated his paper with bile to help it absorb the colors  better, without smudging. The rest of the team followed  his lead on the bile-paper, all of which meant they could achieve  crisp details needed for things like veins, nerves, and the many textures  of tissue under our skin.

The combination of beauty  and accuracy is captivating, especially to other anatomists.   I saw that for the first time  when I was a graduate student in the University of Cincinnati, School of Medicine, and my professor had gone out and  bought this atlas, and that was in 1968. So I remember taking one of  the copies, one of the volumes, into my office in the department of surgery, and looking at it and just being almost mesmerized by these incredibly beautiful paintings. That’s David Williams, a retired professor  of medical art from Purdue University, and scholar of the Pernkopf Atlas.

For Williams, the allure of the  artistry of this book was immediate. And that fascination just  stayed with me through a long, somewhat torturous path that took me  eventually to Vienna and then to Innsbruck, where I was able to live with and study with the last painter who had  contributed to this atlas. He’s referring to Batke, who lived until 1983, and enjoyed a quiet career to his final days, spending most of his time in seclusion, painting.

Williams saw Batke as one of the most  talented painters who worked on the book, so much so that he went to study  under him briefly in the 1970s. I met Franz Batke at the anatomy  Institute at the University of Innsbruck, and he had, in my opinion, he  had sort of imprisoned himself in the anatomy Institute, and he  had a place that was given to him or provided to him in the anatomy institute that consisted of a very rudimentary bedroom. He had a bathroom, and then he had a room that was sort of a combined, a studio area.

I tried to tell him that I had  come to meet him and to learn how he had made these gorgeous paintings. And it was really that simple at that time, I really didn't know the history behind the work. I didn't know that he had been a Nazi.

I just really admired his painting technique and wanted to learn the same technique. So Williams wanted to study under this  incredible illustrator while he was still alive, which is why - wait, what was  that about Batke being a Nazi? Yeah, turns out that Pernkopf wasn’t the  only big fan of fascism on this team.

The reason we know this is that they drew a bunch of Nazi symbols in their signatures. Which made it into the book. The most obvious examples came from Lepier, who often signed his paintings with “Lepier Wien”, Wien being the German name for  Vienna, where the paintings were made.

Adding the second word made it possible for Lepier to sneak in a swastika into  the space between them. He started doing so in 1937, when  the Nazi party was banned in Austria, so he had to be pretty committed to Nazism  to pull such a risky move at that time. Meanwhile, Karl Endtresser took advantage of the double S’es in his name, turning  them into SS lightning bolts.

Franz Batke wasn’t “lucky” enough  to have any letters in his name that were easy to convert to Nazi symbols, but that might not have  stopped him from joining in. He liked to date his paintings, and in 1944, well, a double 4 can easily become a different  pair of pointed, angular symbols. Now, researchers have debated whether or not that’s actually what he was doing here,  but given that his 4’s look different in every signature in the book that’s  not from 1944… well, you be the judge.

Led by Pernkopf, the artists who  created these images worked tirelessly, with Pernkopf himself often spending  eighteen hours at a time on his work. The project carried on until it  was slowed down by World War 2. Endtresser and Schrott both  became soldiers for the Nazis, and Lepier served as an air raid warden as well.

Batke even went to the front  lines in Russia in 1941, and was wounded while there. Work on the atlas reached a full standstill when the Allies defeated the Germans in 1945. Once American troops entered Vienna, they began a process of “de-Nazifying”  the city and its government.

This involved arresting individuals  who had aligned themselves with the Nazi regime, and subjecting  them to both hard labor and re-education. They were shown videos on the full scope  of the horrors of concentration camps. They had to face the death  machine they’d created and served.

Pernkopf and Batke were among those arrested. The Nazis were defeated, but the rot at the heart of their ideas remained, even in the Atlas. And yet, the swastikas and lightning bolts, and all the other evidence  of its creators’ ideals, somehow never tarnished the  legacy of the book for decades.

It took nearly fifty years for  physicians and researchers to fully contextualize the  Pernkopf Atlas for what it was. Questions started cropping  up as early as the ‘70s, but really rose to the surface in the mid ‘90s, when a dentistry professor named Howard Israel received a vintage copy of the atlas as a gift. He noticed the insignias right away, and  he also observed that a man in the book was drawn with a shaved head, which was  done to political prisoners at the time.

Plus, those swastikas and Nazi symbols that  the artists drew into their signatures? Well, some time after the first edition books were printed in the US, the publishers  figured out that it was a bad look. They did their best to scrub out the most  obvious swastikas from the later editions, which was why these questions only came up when people started examining the  vintage copies in greater detail.

Someone, somewhere along the way had  decided that it was easier to sweep the books’ past under the rug than  to confront them for what they were. But they couldn’t hide this secret forever. In March of 1995, the World  Holocaust Remembrance Center called on the University of Vienna to  conduct an investigation into the issue.

They wanted to determine if any of the people depicted in the atlas could be identified,  as Holocaust victims or at all. According to Sabine  Hildebrandt and other scholars, it’s unlikely that any victims of  concentration or execution camps were sent to Vienna, so the images  aren’t of Holocaust victims per se. Instead, these Nazi artists took  a page from a much older playbook.

Now, what happened under the Nazis from 1933 on was that the legislation was changed. It became much more severe,  whereas in the Weimar Republic, that democratic system before 1933, we have only one reason that led  to a capital punishment verdict. That was high treason and aggravated murder.

Under the Nazis, we get 40  different reasons to give a person a verdict of capital punishment. That could be things like listening to  enemy radio, especially during the wartime. It could be speaking badly about Hitler.

It could be stealing from a bombing site. It could be stealing packages from the mail. So all of these reasons led  to... an extremely high number of executions following military  and civilian verdict.

So we're not talking here about so much about the bodies that came from the camp systems. Those were also delivered  actually to the anatomists. But we're talking here specifically  about the bodies of the executed.

It was the Murder Act all over again,  but this time, on a much larger scale. So we see, and this is a conservative  estimate, a rise, an exponential rise, especially during the war years,  of altogether 30,000 executions. And most of these bodies were made  available to the 30 anatomical institutes that we can find in Germany and the  annexed extent and occupied territories.

And I do want to be clear here. Pernkopf was not the only Nazi doing research on anatomy and medicine during this time. There were a lot of other  doctors and scientists who chose to exploit the vulnerable people, the  victims of the Holocaust death camps and those who stood up against the Nazi regime.

Pernkopf’s contribution to this  industry of evil stands out because, well, he wrote it all down and  published it in his atlases. The University of Vienna’s investigation  found that at least 1,337 bodies sent there during the book’s  creation were Landesgericht, political prisoners sentenced to death. Seven of them were Jewish.

However, they couldn’t determine if any  of these political prisoners’ bodies were used by Pernkopf specifically,  even though some of Pernkopf’s former coworkers say that they were. The investigators only confirm that  the anatomy school received them for dissection, not where they went after that. This is partly because the  cadavers were anonymized after reaching the medical school,  and partly because the building where most of the records  were kept was bombed in 1945.

Still, scholars like  Hildebrandt are pretty sure that whatever the number of  Landesgericht may be, it’s not low. And then we also know, and this is  from newer research that we were   able to glean from witness interviews at the time, is that it is highly likely that  hundreds of these bodies were used for those images that were created during  the war period and possibly even after, because we now know that some  of the bodies of the victims also remained at the Vienna  Institute after the war. That's often a forgotten fact, but  especially the head and neck volumes might still have images based  on bodies of Nazi victims.

That said, we don’t know if every image  was based on these executed people. Remember, volumes three and four came out in 1952 and 1960 respectively,  well after the war was over. Plenty of paintings were made well  after the Nazi regime was dismantled, but it’s a question of whether  they got new bodies in after that, or kept using the ones they had.

The records and original  paintings for the Atlas that still exist were donated to the Josephinum  Medical History Museum in Vienna. The original publishing company for  the Atlas, Urban & Schwarzenberg, was acquired in 2003 by the  academic publishing house Elsevier. Urban & Schwarzenberg had stopped  printing the atlas in the mid-90s, and Elsevier wisely decided  to keep with that precedent.

In 2019, Elsevier also granted the Josephinum  all publishing rights to the paintings, with explicit limitations on  how and when they can be used. When it comes to the Pernkopf Atlas, the legacy of profiting from the  exploitation of the Nazis’ victims was over. Those with the power to do so  were seeking to make things right.

But future chapters of its  story have yet to be written, and there’s still plenty to discuss  about what they will contain. Although it’s nearly 100 years old, the  Pernkopf Atlas has been described as “the pinnacle of color anatomic illustration,” and that made it vital in anatomy  education for generations. Those images, even though because of  the political background of the atlas, the book is no longer printed.

Those books that are still around are  still being used by some, not by many, but by some, especially by some  surgeons who have essentially learned to see the human body with those images. So that's a process. Learning anatomy is very much the  learning of recognition of patterns.

And once you learn to look in a particular way, those images can help you as orientation. And that's been documented well for surgeons. It also still, especially  for head and neck surgeons, is still a favorite and for students.

Basically, if you used Pernkopf  to learn anatomy the first time, it shapes how you think of the body, forever. There’s also a sort of artistry  to the approach that both Pernkopf and the illustration team took when it  came to depicting the layers of tissue. Our bodies are three-dimensional objects, and displaying that in two  dimensions is a challenge.

The Pernkopf Atlas often shows  the same part of the body dissected in these layers,  moving from superficial to deep. This means that you can easily  infer the pieces of the body that lie on top or underneath,  and get around that 2-D problem. What he brought together was  a topographical approach.

That means that you show the  human body region by region, and you also go from superficial  to deep, so in layers. He was very, very thorough. So we have here one of the most detailed atlases, and he probably copied some of the best  atlases that already existed at the time.

Part of what made the book so striking  was really just a lucky coincidence. See, the first edition of the book came  out just after a new printing technique was invented that allowed  for the layering of colors, which gives the watercolors in  Pernkopf an almost luminous quality. And, used a technique that was at the time new, a four-color printing technique that  allowed for a much more differentiated color palette on these images so  that very clearly these images stood out from anything that  had ever been produced before.

All in all, this combination of  impeccable artistry and immaculate detail made Pernkopf the gold standard of  all anatomical texts for decades. And they had a very particular view for detail. So it gives you, this particular  atlas gives you much more detail, especially in certain regions.

So peripheral nerve surgeons, for example, see more than they see in any other general atlas. The head and neck surgeons see much  more than they see in any other atlas. So he basically created an atlas that served as all-round information of the highest detail.

Although in a somewhat ironic twist,  the contributions that Pernkopf made in his own hand, the descriptions  of what the images show, are some of the least interesting  parts of the whole thing. And specifically, the German originals  are actually pretty tedious to read. It's about seven volumes, big books like this.

I mean, enormous. Because he was actually obsessive  compulsive in his writing. So that for the popular  English version of the Atlas, only the image plates were used  and the legends, and not the text.

The text is basically unreadable. Even for a specialist, you wouldn't  want to read all that detail that he put in that book. But the plates are still being used.

At least, used by some. As you can imagine, not everyone agrees on whether anyone should be using this book at  all, whether to study or to do surgery. So if using this book is the  difference between success and failure, and using it is the only path  towards helping people today, does that make it worth using?

Well, not everyone agrees. But for people like Rabbi Joseph  Polak, there’s a pretty clear answer. Polak has studied the ethical  handling of Holocaust-era human remains in accordance with Jewish law, and even created The Vienna Protocol, a series of guidelines for  archaeologists to follow.

The protocol is pretty straightforward. There must be an effort to identify  the remains, inform any next of kin, and the remains should be either transferred to their descendants or reburied promptly. But this doesn’t address how  we reckon with human remains that only exist as ink and paper, as  images, divorced from their names.

Which is why a surgeon named Susan Mackinnon reached out to Rabbi Polak  to ask for his thoughts. Susan Mackinnon phones me up  somewhere in the last 10 years. She doesn't know me from a  hole in the wall, and she says, You're the author of the Vienna protocol, right?

I said, Yeah, I'm the author  of the Vienna protocol. I had some partners doing it,  but I'm the principal author. She says, I have a question for you.

She's the head of hand surgery,  and really that kind of surgery anywhere on the body at Wash U in St Louis, and she says she's got a patient who  has excruciating pains in her knee. The patient has said to her, either you  find the nerve in my knee and take it out, or else I want you to amputate. She opens the knee.

She can't find the nerve. She said she knew exactly what she had to do. She had an anatomy Atlas in her  locker that she could consult, and she was pretty sure that  that would have the dirt.

She called me and basically saying,  is this the right thing to do? You can guess which anatomy atlas that was. See, Pernkopf is especially noteworthy for  the level of detail in the nervous system, particularly the peripheral nerves.

Nerves are tricky, and even an incredibly  skilled surgeon might struggle to find them amongst all the other soft tissue. And since nerves are hard to repair, it’s vital that you can identify exactly what you’re looking at so you don’t make the wrong cut. Which explains why some doctors might  need to consult an atlas to find the correct structure to do as little damage  as possible to the surrounding tissue.

Which is why they need Pernkopf. So I said, I said to her, it is  absolutely the right thing to do, if you can take away pain from somebody  and heal them by looking at this atlas, you are giving meaning to the  murders of all the peoples whose body parts are displayed in the Atlas. But more than that, in Jewish law, we are  not permitted to benefit from remains.

So you would think that there  is a conflict, but there isn't. There isn't a conflict because we're talking about benefiting from remains and  not drawings of remains. In other words, if she had body  parts there, I would want to go, that would be a much higher level  question in Jewish law, but it isn't that.

But I said there is one thing you have to  do, and that's part of the Vienna protocol, and that is, you have to tell  everybody what you're doing, what you're consulting and is it okay with them? And she went to the family, and  she went to this woman and said, I'm going to go to my locker,  I'm going to look it up. But you, I need you to understand  what it is, what I'm doing, and are you okay with it?

And of course, everybody was okay with it. After consulting the atlas, Mackinnon completed the surgery and her patient was  relieved of their debilitating pain. For Polak, the biggest factor  in all this is informed consent.

Just like a patient needs  to be told about everything that’ll happen to them during a procedure, they need to know if their surgeon is  consulting this book, and its history. This allows everyone to pay  their respects to those victims, who never wanted to be immortalized on paper, let alone by such evil people. Which is also why so many people  refuse to use the book at all.

I think my sense of speaking to doctors  that have gone to it is that it's terrific, but really it's like, I don't want  to touch it because it's grubby. That's the sense that they had. They don't want it, they don't want it, and we're waiting for  something better to come along.

And no, we’re not there yet. Despite all the fancy imaging technology we have, most anatomists and doctors still rely  on the work of medical illustrators. Which might surprise you if you’re  not trained in any of those fields.

We have everything from  x-rays and MRIs to 3D scanners and just plain old photographs. Surely looking at the real  thing as it appears in real life is better and more accurate than some doodle. How could a drawing possibly be better than the finest imaging technology science can invent?

To get to the bottom of that question,  we spoke with Leah Leibowicz, the director of the Biomedical  Visualization Program at The University of Illinois at Chicago. She talked with us about the vital  role that medical illustration can play in education, both  for doctors and patients. Medical illustration plays such  a fundamental role in education.

And it really comes back to  how we clarify what's going on that might be really complex  and hard to understand. So images exist, right? And photos and scans.

And you can say, well, you know, what's  the need for medical illustration when you can just go take a photo of something or, you know, take an image or a scan  of something and use that to learn. And that's true. That can be very meaningful.

And you can take information from that. But it's not being curated. It's not being able to clarify certain pieces  that may be very difficult to understand.

Think about a surgical field,  taking an image that might be going on during a surgery  could be very complex and hard to kind of understand what's  actually going on in the anatomy. And our role as biomedical  visualizers is really to come in and clarify and understand,  okay, who is our audience? What do they need to know to be able  to kind of get to the next step, to deeper their understanding  or deeper their learning?

And we can help clarify that  by building in connections, understanding someone's pre-knowledge, and creating visuals that really meet somewhere where they are to deepen that understanding. Part of the medical illustrator’s job  is not just deciding what to depict, but how to show it, and figuring that out means deciding who your final  illustration is really for. For medical professionals,  this usually means finding ways to emphasize the 3D nature of the body.

Pernkopf accomplished this with those  superficial-to-deep image series that I mentioned earlier, along  with a few other techniques. In some cases, they’d paint some body  parts so they looked translucent, meaning that everything  underneath was clear to see. Another technique was so  popular that it’s influenced a lot of medical illustration  since then: Color coding.

It’s now commonplace that anatomy  diagrams draw arteries in red, veins in blue, and nerves in yellow. While Pernkopf might not be the first to do this, some of the most striking  images in the whole atlas are those that depict incredible networks  of branching vessels rendered in shimmering reds and blues. It’s hard to imagine that these images didn’t have a major influence on the style preferences  of future medical illustrators.

Because Pernkopf has been held up as  a pinnacle of anatomy for so long, it’s impossible to deny that the book influenced a lot of how anatomy is drawn, even today. Fortunately, programs like the  one at University of Illinois at Chicago work to make their  students aware of these problems. So I think especially with the Pernkopf Atlas, it's very much known for its technically  beautiful illustrations, right?

It's always been, like in addition  to the ethical concerns that it has, but it's always been looked at like, oh, this is a beautiful way of rendering  tissue and arteries and vessels. And so very old school medical illustration, I think it was always very  much revered of like, oh, this is the standard, the ideal,  and people learn from that. And so I think you'll see sometimes  where older medical illustration just keeps getting published, even  though there might be concerns and problems with it, but it becomes  like, well, that was the gold standard.

And we need to really question like,  well, why is that the gold standard? Is it just a really beautifully rendered piece? But we can't ignore all the other things  that we really have to consider, right?

Those ethical concerns, but in addition, diverse body types and being  inclusive to the bodies and anatomy that we see and making sure that we're  really training future clinicians to be as prepared to work  with no matter, you know, body size, shape, no matter  who they might be encountering. So while illustrators can appreciate  the skill and artistry of this atlas, there’s a desire to think about new ways  to approach anatomical illustrations. We want to close the book on Pernkopf, but doing so requires us to think  entirely differently about how we teach, and how we learn, what is inside our bodies.   The Pernkopf Atlas hasn’t been in print for  decades, and likely never will be again.

The only sales of Pernkopf copies occur  on secondhand reseller sites like eBay, where a complete copy in good condition can fetch hundreds or even thousands of dollars. There are also scans of the atlas online, and anyone who chooses to reference them can do the research to find out  the book’s uncomfortable history. And critically, the word  is out about that history, meaning that doctors and  anatomists who do use it can warn their colleagues and pay their respects  to the victims depicted in its pages.

But this may not be the end of the atlas. Like I said, the illustrations are online. And when images are on the Internet, they can be scraped and used  to train generative AI models.

I'm already seeing the first AI  generated images that clearly have used the Pernkopf Atlas, without  any clue by the user of the atlas or the creator of the image with the AI model, that they've been using the Pernkopf  Atlas, and what the Pernkopf Atlas is. These illustrations are  living on in the AI models, entirely separate from any context or  recognition of where they came from. The victims have become digital ghosts, haunting the algorithms that spit  out mangled versions of their bodies.

And not for nothing, but  the images aren’t even good. These classical atlases have had  hundreds of years of development. And I think to create a whole  new set of images that show us what we need to see will  take a little bit of time.

And specifically, as everybody is  messing around with AI models currently, I mean, those images are so bad. You wouldn't believe it. They have nothing to do with accurate accuracy and certainly are not history informed.

It takes years or even decades  to become an expert in anatomy. So when AI tries its eight-fingered  hand at making anatomical diagrams, it’s hardly a surprise that the images  aren’t going to be all that accurate. So no, AI is not going to save  us from the need for Pernkopf.

And that’s a real shame. To think that there’s simply no replacement. We’ve reached the pinnacle  of medical illustration, and that means that we’re  forced to train the best of us – the healers and helpers – on a book that’s  the result of crimes against humanity.

We’re just never going to surpass Pernkopf. Except… hold on. That’s a terrible attitude!

I mean, says who? There’s nothing stopping us from  starting fresh and making a better, more ethical resource for anatomists to use today. That’s where Dr.

Kalyanam Shivkumar comes in. He’s a physician and researcher at UCLA, and has spent most of his  career learning just about everything there is to know about the human heart. Shivkumar first learned of the Pernkopf Atlas, as many other scholars did, by hitting the books.

Any scholar in any field, when you  start reading about a given area, you start looking into the literature, you  try to see who is published in that area. So the main source was actually  reading the literature, going to the library, talking  to experts, reading the papers, soon it became obvious that almost all the key anatomical works in the literature  were a derivative of Pernkopf. Shivkumar’s research into Pernkopf led him  to all the findings we’ve laid out here.

But for him, knowing what Pernkopf  really was, was only the beginning. And the scholars there, of  course, have written about it. And they decided that they're not  going to publish that work anymore.

At that point, that's when I looked at it  and said, okay, where does this leave us? There were two schools of thought. People said, oh, let's just  acknowledge what happened.

And it is useful. In fact, when you  look at very thoughtful surgeons, people have used... the  atlases, especially to get, you know, the peripheral nerve anatomy,  which is exquisite, which we needed. That's the moment when it occurred to me.

And I simply, in my initial reaction, I said, okay, you know, we just have to surpass it. Easier said than done. Remember, the original atlas was made  over the course of more than twenty years, by lots of generational  talents, and with essentially unlimited funding from a publisher.

One of the biggest barriers  to surpassing Pernkopf is just how many resources were available to the makers. They had tons of funding and support from  their publisher and from the University. So it was going to take a massive  amount of work to even try to match up.

Work that Shivkumar was willing to put in. Thus, the Amara Yad project was born. Amara Yad was a project that was  created because of my singular desire to do something about an injustice that I had seen.

I was discussing this with my colleagues here and one of my teachers and now colleague  at UCLA, Professor Barbara Natterson, I was just talking to her and we coined the term. We're going to call it Amara Yad. Amara means immortal in Sanskrit,  and yad means hand in Hebrew.

So the Amara Yad project aims  to become an immortal hand, forever pushing the boundaries of what researchers can understand about the human body. The hope is that the Amara Yad project can produce atlases that are even better than Pernkopf. We're going to replace these atlases  and provide some of the criteria was to have it ethically sourced, the absolute best quality of information, open access.

No barriers, no walls. Anyone,  anywhere in the world can access this. Right this minute, you know,  a few keyboard clicks away, you can download two very  beautiful volumes of the Atlas.

It's available for the entire world. It's funded by donors and it's funded by the taxpayers of the United States of America. You know, so I think that is, in many ways, it's an expression of our  deep desire to be of service to other human beings, as simple as that.

While that desire may be simple, the reality of making something like this is anything but. There are dozens of people  across tons of specialties who all have to come together to make  something like this even possible. So yes, it starts off with physicians.

It starts off with proceduralists, surgeons, working with anatomists, PhD scientists. But we are also working with  people who are digital experts, you know people who can  capture digital information. We are working with people  who actually are artists, who are able to take digital information.

So now we're getting information  from many different sources, but it also goes through the  filter of an artist's eye. We're also working with people  who teach medical ethics. We are now having some initial conversations  with the Hebrew University in Israel.

They, including our schools at  Oxford, Institute of Science, we are having ethicists who are working with us. So it's brought together a lot  of people, you know, obviously, now, my expertise is only in some of these areas, but that's kind of what the project is. We've already planned seven volumes  of the Atlas for the human heart, but we're extending to other  parts of the human body.

And also what we're doing  in this process is we are learning new ways of archiving information. We've also expanded our  work to identify canonical, very critical pieces of teaching material  that will inform medical practice. Instead of having to struggle with  the fruit of a poisonous tree, why don't we create something new?

To many of us, Pernkopf feels different  from other Nazi medical atrocities because we can see it, hold it, interact with it. This book is a physical, tangible work of devotion to both cruelty and healing,  rendered in paint and ink. To tell this story, we had  to grapple with that reality when we bought copies of it online.

Holding these books, seeing them… it’s chilling. Without context, these images can be beautiful, but once you know the history,  it's impossible to overlook the fact that you're looking at the  bodies of executed political prisoners. And we know that we’re not the  right people to keep these books.

There are students and scholars  who’d benefit from these, which is why we are donating them to the Health Sciences Library at the  University of Illinois at Chicago. They’ll be sent to their rare books collection and archived with the full  context of what the books are. Any researcher who checks these  books out will also be given articles on their history, including a letter from  the University of Vienna about its past.

If there’s anything we can  learn from the Pernkopf Atlas, it’s that we must be willing to  look uncomfortable truths dead-on. Scraping away the evidence of a swastika  doesn’t undo the fact it was drawn. Denying unsavory history does not  change it into something more palatable.

This was a story about death,  ambition, medicine, and power. But by talking about it for what  it is, we can change the story from one of evil into a story of redemption, where we learn from the sins of  our past and work to do better. For everyone in the Atlas’s pages.

For Edith Morrey. For every person whose bones are on  display that did not want them there. Dig out the poisoned trees,  and grow something new. [♪ OUTRO]