Anatomy in the Third Reich: An outline,part 1. National Socialist politics,anatomical institutions,and anatomists

Although it is known that anatomists working in Germany during the Third Reich have used bodies of victims of the National Socialist (NS) regime for dissection and research, a comprehensive history of the anatomy in the Third Reich has not yet been written. Recent studies of the history of German anatomy departments during this time period provide material for a first outline of the subject matter. A historical review can help with the formulation of ethical foundations in modern anatomy. From the outset, the NS regime sought to reorganize German universities according to NS leadership principles and political goals. Many German academics, especially physicians and among them anatomists, followed these intentions with a voluntary “self‐alignment” that encompassed their professional actions as well as their ethics. Currently, political information is available for 111 of 178 anatomists. Thirty‐eight of the anatomists were dismissed for racial or political reasons, among them 10 chairmen of anatomy, whereas 35 of the anatomists were politically active members of one of the NS organizations. Over 70% of the chairmen of anatomical departments in the time period from 1941 to 1944 were members of NS organizations. Anatomists, as so many other physicians and academics, belonged both, to the group of victims of the regime, i.e., those being dismissed from their positions for racial and political reasons, and to the group of supporters and sometimes active perpetrators of NS policies. Clin. Anat. 22:883–893, 2009. © 2009 Wiley‐Liss, Inc.     

Anatomy in the Third Reich: an outline,part 3. The science and ethics of anatomy in National Socialist Germany and postwar consequences

Anatomists in National Socialist (NS) Germany did research on materials from animals and humans, including tissues from the bodies of NS victims. The research was competent but rarely innovative. This may be due to the isolation of the German research community from international developments, as well as to the dismissal of a great number of successful anatomists for racial or political reasons. Other research was unproductive because of its foundation in the pseudoscience of racial hygiene. Anatomists in the Third Reich acted according to a new set of medical ethics favored by the NS regime. Not the individual human being but the “body of the people” as a whole was the object of this ethics. Every action was ethical that ensured the health of the German people, including sterilization, so‐called euthanasia, and finally mass murder. Anatomists made use of the opportunities given to them by the NS regime, which led to the postmortem utilization of the bodies of NS victims. After the war, most anatomists retained their positions and NS history was not discussed until the later 20th century. Since then, historical research and public discussions have led to an increased awareness of questions of ethics in anatomy. The history of anatomy in the Third Reich illustrates that the theory and practice of a science is dependent on the political system it exists in, and that the scientists' competence not only in their science but also in politics and ethics is a prerequisite for the freedom of science. Clin. Anat. 22:906–915, 2009. © 2009 Wiley‐Liss, Inc.     

Current status of identification of victims of the National Socialist regime whose bodies were used for anatomical purposes

Research on the history of anatomy in the Third Reich has often focused on anatomists who collaborated with the National Socialist (NS) regime. Only recently has attention shifted to investigations of the victims, of which there are two groups: anatomists whose careers were disrupted by NS policies, and victims of the NS regime whose bodies were used for anatomical purposes. No systematic approach has yet been undertaken toward the identification of all the different groups of victims and the individuals' fates. This overview of currently available data on NS victims whose bodies were used for anatomical purposes reveals that an estimated total number of all bodies delivered to departments of anatomy lies at more than 40,000, and the so far documented number of executed persons among them at a minimum of 3,749. The traditional sources of body procurement and their significant changes in character during the NS period can be traced. Postwar attempts on finding the fate and identity of bodies of NS victims in anatomy can be divided into three phases. Most investigations focused on the removal of remaining “material” from NS victims from the anatomical collections, while identification and remembrance of individual victims was not a priority. So far, about 500 NS victims' names and biographies have been at least partially identified. Existing memorials rarely name individuals. New approaches to the identification of victims and the potential of a databank for these victims' biographies as an appropriate manner of remembrance are examined in this study. Clin. Anat. 514–536, 2014. © 2013 Wiley Periodicals, Inc.     

Anatomy during the Third Reich--the Institute of Anatomy at the University of Marburg, as an example.

A complete documentation of German anatomical science and its representatives during the period of national socialism has not been published as yet--contrary to the situation in other medical disciplines. Instead of German anatomists, American anatomists have occasionally addressed this issue during their meetings and have reported on special aspects, such as the use of Nazi symbols in anatomical textbooks and atlases (Pernkopf 1952) and the use of corpses of justice victims for anatomical research and student education. Also, the genesis of the atrocious collection of "racial" skulls, initiated along with the SS-institution of the "Ahnenerbe" by the anatomist August Hirt of Strasbourg (who ordered more than 90 inmates from concentration camps to be murdered in the gas chamber built in the concentration camp of Natzweiler-Struthof close to Strasbourg, Alsace) has been described by Frederic Kasten and others. A broader view of the patterns of behaviour and political actions and fates of contemporary scientists, ranging from dismissal to clandestine opportunism, affirmative cooperation and fanatic activism can be obtained by the analysis of the activities in research, medical education and academic positions of the following members of the Institute of Anatomy at the Philipp-University in Marburg: Ernst G?ppert, Eduard Jacobshagen, Ernst-Theodor Nauck, Adolf Dabelow, Helmut Becher and Alfred Benninghoff, whose activities and fates differ in several respects and allow more general deductions. Also, the individual fates of a number of prosecuted Jewish anatomists (Wassermann, München; Poll, Hamburg), of devoted and active members of the Nazi party (Clara, Leipzig; Blotevogel, Breslau) and of criminal fanatics (Hirt, Strasbourg; Kremer, Münster) are briefly discussed. The present contribution is an attempt to initiate a more detailed study of all German departments of anatomy during the Hitler regime and to generate a public discussion among the younger generation of German anatomists.     

The evolving ethics of anatomy: Dissecting an unethical past in order to prepare for a future of ethical anatomical practice

Anatomical practice has arguably one of the most ethically challenging histories in the medical sciences. Among the oldest scientific disciplines in medicine, dissection of the human body for scientific purposes occurred as early as the third century Before the Common Era. Throughout the history of anatomical practice, human dissection has occurred in ways that cross the line from progressing medical science to violating the sanctity of the human body. The dissection of the human body creates ethical dilemmas which stem from the need for anatomical science to gain medical knowledge in juxtaposition with prevailing religious and moral views surrounding anatomy as a threat to the sanctity of the human body. This article examines the unethical history of human dissection throughout the ages and explores the rationale behind the unethical practices. In addition, this article explores imperative modern day ethical standards in anatomy including, the ethical handling of human bodies, respecting human life, and ensuring informed consent for dissection of bodies that are donated. Finally, this article explores the question of which ethical prism we should use when dealing with anatomy collections or works of the past. Learning both the history of unethical practices in anatomy and the rationale behind them is imperative so that the discipline can prepare for an ethical, diverse, and inclusive future. This article provides a foundation for understanding the evolution of ethics in anatomical practice and is a valuable resource for students and anatomists alike.     

Swedish–German contacts in the field of anatomy 1930–1950: Gösta Häggqvist and Hermann Stieve

This study presents a first exploration of Swedish–German contacts in the field of anatomy between 1930 and 1950, a subject of research that has only recently come into focus. Based on the background of the general cultural and scientific exchange between Sweden and Germany and the biographies of the Swedish anatomist Gösta Häggqvist (1891–1972) and his German colleague Hermann Stieve (1886–1952), this study identifies specific areas of collaboration between anatomists of the two countries. These include mutual professional career advancement, publication of research results, the exchange of technological expertise and transfer of anatomical specimens. The investigation also examines the use of “material” from executed persons in Sweden and Germany as well as public postwar critiques of this practice. Open research questions on Swedish–German interactions in anatomy during this time period are formulated. The contacts between Häggqvist and Stieve give insight into the impact of scientific collaborations and controversial political liaisons in the relationship between Swedish and German science in recent history. The study is based on documents from German and Swedish archives, including Nobel Prize nominations and reports from the Nobel Archive for Physiology or Medicine in Stockholm.     

Anatomical informatics: Millennial perspectives on a newer frontier

One of the most ancient of sciences, anatomy has evolved over many centuries. Its methods have progressively encompassed dissection instruments, manual illustration, stains, microscopes, cameras and photography, and digital imaging systems. Like many other more modern scientific disciplines in the late 20th century, anatomy has also benefited from the revolutionary development of digital computers and their automated information management and analytical capabilities. By using newer methods of computer and information sciences, anatomists have made outstanding contributions to science, medicine, and education. In that regard, there is a strong rationale for recognizing anatomical informatics as a proper subdiscipline of anatomy. A high-level survey of the field reveals important anatomical applications of computer sciences methods in imaging, image processing and visualization, virtual reality, modeling and simulation, structural database processing, networking, and artificial intelligence. Within this framework, computational anatomy is a developing field focusing on data-driven mathematical models of bodily structures. Mastering such computer sciences and informatics methods is crucial for new anatomists, who will shape the future in research, clinical knowledge, and teaching.     

How the Pernkopf controversy facilitated a historical and ethical analysis of the anatomical sciences in Austria and Germany: a recommendation for the continued use of the Pernkopf atlas

Eduard Pernkopf's Topographical Anatomy of Man has been a widely used standard work of anatomy for over sixty years. International inquiries about the National Socialist (NS) political background of Eduard Pernkopf and the use of bodies of NS victims for the atlas were first directed at the University of Vienna in 1996. A public discussion about the further use of the book followed and led to the creation of the Senatorial Project of the University of Vienna in 1997. This historical research project confirmed the strong NS affiliation of Pernkopf and revealed the delivery of at least 1,377 bodies of executed persons to the Anatomical Institute of Vienna during the NS time. The possible use of these bodies as models cannot be excluded for up to half of the approximately 800 plates in the atlas. In addition tissue specimens from NS victims were found and removed from the collections of the Viennese Medical School and received a burial in a grave of honor. The Pernkopf controversy facilitated the historical and ethical analysis of the anatomical sciences in Austria and Germany during the NS regime. The continued use of the Pernkopf atlas is not only justifiable but desirable as a tool in the teaching of anatomy, history, and ethics.     

Bygone theatres of events: A history of human anatomy and dissection

Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.     

Systematic reviews versus narrative reviews in clinical anatomy: Methodological approaches in the era of evidence‐based anatomy

Two main types of review articles with distinct characteristics and goals are commonly found in the scientific literature: systematic reviews and narrative (also called expert or traditional) reviews. Narrative reviews are publications that describe and discuss the state of science on a specific topic or theme from a theoretical and contextual point of view with little explicit structure for gathering and presenting evidence. Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence‐based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy. The goal of this perspective article is to address the key differences between narrative and systematic reviews in the context of clinical anatomy, to provide guidance on which type of review is most appropriate for a specific issue, and to summarize how the two types of reviews can work in unison to enhance the quality of anatomical research and its delivery to clinicians and anatomists alike. Clin. Anat. 31:364–367, 2018. © 2018 Wiley Periodicals, Inc.     

Capital punishment and anatomy: history and ethics of an ongoing association

Anatomical science has used the bodies of the executed for dissection over many centuries. As anatomy has developed into a vehicle of not only scientific but also moral and ethical education, it is important to consider the source of human bodies for dissection and the manner of their acquisition. From the thirteenth to the early seventeenth century, the bodies of the executed were the only legal source of bodies for dissection. Starting in the late seventeenth century, the bodies of unclaimed persons were also made legally available. With the developing movement to abolish the death penalty in many countries around the world and with the renunciation of the use of the bodies of the executed by the British legal system in the nineteenth century, two different practices have developed in that there are Anatomy Departments who use the bodies of the executed for dissection or research and those who do not. The history of the use of bodies of the executed in German Anatomy Departments during the National Socialist regime is an example for the insidious slide from an ethical use of human bodies in dissection to an unethical one. There are cases of contemporary use of unclaimed or donated bodies of the executed, but they are rarely well documented. The intention of this review is to initiate an ethical discourse about the use of the bodies of the executed in contemporary anatomy.     

From cradle to grave via the dissection room: the role of foetal and infant bodies in anatomical education from the late 1700s to early 1900s

The preponderance of men in the narrative of anatomical education during the 1800s has skewed the historical perception of medical cadavers in favour of adult men, and stifled the conversation about the less portrayed individuals, especially children. Although underrepresented in both the historical literature and skeletal remains from archaeological contexts dated to the 1800s, these sources nevertheless illustrate that foetal and infant cadavers were a prized source of knowledge. In the late 1700s and 1800s foetal and infant cadavers were acquired by anatomists following body snatching from graveyards, from the child's death in a charitable hospital, death from infectious disease in large poor families, or following infanticide by desperate unwed mothers. Study of foetal and infant remains from the 1800s in the anatomical collection at the University of Cambridge shows that their bodies were treated differently to adults by anatomists. In contrast to adults it was extremely rare for foetal and infant cadavers to undergo craniotomy, and thoracotomy seems to have been performed through costal cartilages of the chest rather than the ribs themselves. However, many infants and foetuses do show evidence for knife marks on the cranium indicating surgical removal of the scalp by anatomists. These bodies were much more likely to be curated long term in anatomical collections and museums than were adult males who had undergone dissection. They were prized both for demonstrating normal anatomical development, but also congenital abnormalities that led to an early death. The current findings show that the dissection of foetal and infant cadavers was more widespread than previous research on anatomical education suggests. This research details the important role of the youngest members of society in anatomical education during the long 19th century, and how the social identity of individuals in this subgroup affected their acquisition, treatment and disposal by elite medical men of the time.     

Anatomical practice at Göttingen University since the Age of Enlightenment and the fate of victims from Wolfenbüttel prison under Nazi rule

This report briefly summarises anatomical practice at G?ttingen University from its founding in 1737 until the Nazi period and gives a detailed account of how Nazi death penalty legislation and execution practice at Wolfenbüttel prison influenced the decision-making of the anatomists in charge at that time. Problems in the procurement of corpses, encountered almost continuously throughout Europe since the broad introduction of dissection into medical training in the early 18th century, were absent in G?ttingen during periods of overt progress in anatomical sciences, e.g. under Albrecht von Haller (in office 1736-1753) and Jacob Henle (1853-1885), and at times when existing regulations were rigorously enforced by the authorities (1814-1851). Ample availability of corpses in the wake of more than 600 executions in Wolfenbüttel between 1935 and 1945 was curtailed only by transportation fuel shortages and resulted in the dissection of more than 200 Nazi victim corpses in the G?ttingen anatomy course. Apparently, neither individual offers of voluntary body donation (dating from 1932 to 1937 and published here as the earliest documents of this kind), nor the strong tradition of high-level anatomical research, nor even the awareness of the University's Age of Enlightenment origin, prevented the unethical use of corpses of Nazi victims for medical teaching. The G?ttingen example may add "historical and moral detachment" under unusual political and wartime pressures to the "clinical and emotional detachment" thought to prevail amongst anatomy personnel (Hildebrandt, in this issue); together with the other reports it calls for all anatomists to bear in mind their ever present ethical obligations in respect to activities involving the use of corpses, both in medical schools and in the public domain.     

The use of executed Nazi victims in anatomy: Findings from the Institute of Anatomy at Gießen University,pre- and post-1945

There is increasing evidence that both during the time of National Socialism, and in the post-World War II-period, the corpses of executed victims of the Nazi regime, as well as body parts taken from them were used for teaching and research purposes in German anatomical institutes. The paper addresses the related issues by looking at the case of the Institute of Anatomy at Gie?en University whose director, Ferdinand Wagenseil, is documented to have had certain political reservations towards the Nazi regime, but at the same time used the situation to get access to more corpses, most likely for teaching purposes. On a second level, new archival sources are used to explore to what extend corpses and body parts of Nazi victims were used in the post-WW II period. One central aim in this context is the reconstruction of the identities of these victims for the purpose of acknowledgment of the atrocities committed to them, appropriate remembrance, and to possibly enable the respectful burial of the remaining body parts. Further, the case raises the question how anatomists during and after the Nazi period justified for themselves the use of corpses from executed political prisoners, and what might be potential explanations for their reasoning. The historical evidence documents an attitude and value hierarchy which is aware of the disregard of dignity or human rights in the case of the Nazi victims, but which perceives this disregard as of minor relevance compared to the needs of medical teaching, or medical research. It is argued that this mental attitude is not specific for the Nazi period, but that it has been brought to an extreme manifestation in this specific context.     

Getting back together after a break‐up: Relationship advice for anatomists and surgeons

The “surgeon‐anatomist” was originally a single individual who self‐pursued knowledge and understanding of anatomy as the foundation for successful surgical outcomes. However, recent advances in medical education have ironically led to the separation of anatomy and surgery. This physical and emotional “divorce” of anatomists and surgeons into separate individuals has created several critical educational issues for medical and surgical educators including a general lack of anatomical knowledge in medical students and misalignment of graduate medical education procedural specialty training with the Accreditation Council of Graduate Medical Education Core Competencies and now the Next Accreditation System. There are numerous opportunities for anatomists and surgeons to work together to improve educational instruction of established difficult anatomical regions, procedural training, or even develop new techniques and procedures. Similarly, anatomists with specialized training in medical education would be invaluable partners to ensure that procedural assessments align with instructional technologies for truly longitudinal curricula that starts at the medical student level, but stops at the patient outcomes of attending surgeons. This mutually beneficial relationship would be similar to multidisciplinary care teams and current surgeon and PhD/EdD partnerships. The restoration of the relationship between anatomists and surgeons would be invaluable to surgical education and remains an exciting research opportunity. Clin. Anat. 28:931–934, 2015. © 2015 Wiley Periodicals, Inc.     

Research on bodies of the executed in German anatomy: an accepted method that changed during the Third Reich. Study of anatomical journals from 1924 to 1951

While it is known that bodies of the executed were used for anatomical research in Germany during the Third Reich, it is unclear whether this type of work was unique to the time period or more common in Germany than elsewhere. The dissected persons and the anatomists involved have not been fully investigated. This study of anatomical journals from 1924 to 1951 shows that 166 out of 7,438 [2.2%] German language articles mentioned the use of "material" from the bodies of executed persons. In comparison, only 2 out of 4,702 English language articles explicitly mentioned bodies of the executed. From 1924 to1932, 33 of a total of 3,734 [1%] German articles listed the use of the executed. From 1933 to 1938 the number rose to 46 out of 2,265 [2%], and increased again from 1939 to 1945 to 73 out of 984 [7%]. After the war 15 out of 455 [3%] still dealt with "material" from the executed. German anatomists' familiarity with the use of the executed as a standard for healthy tissues even before 1933 may have contributed to the ease with which they accepted the "opportunities" (large-scale studies and research on women) presented to them by unlimited access to bodies of the executed provided by the abusive National Socialist (NS) legislation and continued using them for some years after the war. German postwar anatomy was built in part on the bodies of NS victims. Information given in some publications will help with further identification of these victims.     

Attitudes of professional anatomists to curricular change

Throughout the world, recent developments in medical curricula have led to marked changes in the teaching of gross anatomy. This change has involved decreasing curricular student contact time and the use of new methods for anatomical teaching. Some "modern" anatomists have welcomed the arrival of these novel methods while other, more "traditional," anatomists have fought to maintain the use of cadaveric dissection. Consequently, controversy over teaching methods has developed to the point that "modernist" and "traditionalist" views within the community of professional anatomists seem to have diverged such that the importance of gross anatomy in the medical curriculum is disputed and that cadaveric dissection by students is no longer the preferred method of teaching. This study tests this hypothesis using Thurstone and Chave attitude analyses to assess attitudes to educational change and the importance of anatomy in medicine and a matrix questionnaire that required professional anatomists to relate course aims to different teaching methods. In total, 112 completed questionnaires were received from anatomists who are employed at higher education institutions that use various teaching methods and who span the academic hierarchy. The results suggest that over 90% of anatomists favor educational change and approximately 98% of professional anatomists believe that gross anatomy has an important role to play in clinical medicine. A clear majority of the anatomists (69%) favored the use of human cadaveric dissection over other teaching methods (this method seeming to achieve a range of different course aims/objectives) (P < 0.001; Kruskal-Wallis). Using Kruskal-Wallis statistical tests, the order-of-preference for teaching methods was found to be as follows: 1. Practical lessons using cadaveric dissection by students. 2. Practical lessons using prosection. 3. Tuition based upon living and radiological anatomy. 4. Electronic tuition using computer aided learning (CAL). 5. Didactic teaching alone (e.g. lectures/class room-based tuition). 6. Use of models. The preference for the use of human cadaveric dissection was evident in all groups of anatomists, whether "traditionalist" or "modernist" (P = 0.002, Chi-squared). These findings are therefore not consistent with our initial hypothesis.     

The anatomist Hans Elias: A Jewish German in exile

Hans Elias (1907 to 1985) was an anatomist, an educator, a mathematician, a cinematographer, a painter, and a sculptor. Above all, he was a German of Jewish descent, who had to leave his home country because of the policies of the National Socialist (NS) regime. He spent his life in exile, first in Italy and then in the United States. His biography is exemplary for a generation of younger expatriates from National Socialist Germany who had to find a new professional career under difficult circumstances. Elias was a greatly productive morphologist whose artistic talent led to the foundation of the new science of stereology and made him an expert in scientific cinematography. He struggled hard to fulfill his own high expectations of himself in terms of his effectiveness as a scientist, educator, and politically acting man in this world. Throughout his life this strong-willed and outspoken man never lost his great fondness for Germany and many of its people, while reserving some of his sharpest criticism for fellow anatomists who were active in National Socialist Germany, among them his friend Hermann Stieve, Max Clara, and Heinrich von Hayek. Hans Elias' life is well documented in his unpublished diaries and memoirs, and thus allows fresh insights into a time period when some anatomists were among the first victims of NS policies and other anatomists became involved in the execution of such policies.     

Dissecting the history of anatomy in the Third Reich--1989-2010: A personal account

This paper is a personal narrative of involvement with the revelations of the use of anatomical and pathological specimens of victims of Nazi terror. The narrative documents responses to the question of the retention and use of anatomical and pathological specimens from victims of Nazi terror by leading academic and scientific institutions and organizations in Germany and Austria including the government of the Federal Republic of (West) Germany, the University of Tübingen, the University of Vienna, the Max Planck Society and the Anatomische Gesellschaft. It begins with the public revelations of 1989 and concludes with the September 2010 Symposium on the History of Anatomy during the Third Reich at the University of Würzburg. The narrative documents a 22-year transition in attitude and responses to the investigation and documentation of the history of anatomy and pathology during the Third Reich. The chronicle includes the 1989 proposed "Call for an International Commemoration" by the author, together with the bioethicist Professor Arthur Caplan, on the occasion of the planned burial of the misbegotten specimens and the responses to that proposal.