Nerve Surgeons' Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice
Demetrius Michael Coombs, MD1; Andrew Yee, BS2; Sabine Hildebrandt, MD3; J. Henk Coert MD, PhD4; Susan Mackinnon, MD2;
1The Cleveland Clinic, Cleveland, OH; 2Washington University School of Medicine, Saint Louis, MO; 3Boston Children's Hospital, Harvard Medical School, Boston, MA ; 4UMC Utrecht, Utrecht, Netherlands
Introduction
Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy continues to be controversial due to its origination during the Third Reich, yet it has surgical application for providing intricate and detailed nerve anatomy. Initial inquires in the 1980's resulted in the Senatorial Project of University of Vienna in 1996 and the subsequent removal of the atlas from print. However, it continues to circulate in the used book market without disclosure. The purpose of this study is to assess surgeon perception of the surgical utility for Pernkopf's atlas and obtain guidance to determine its ethical handling.
Materials & Methods
Members of the American Society for Peripheral Nerve (ASPN) and PASSIO Education were surveyed and 206 responses were collected (25.1% response rate, 76.9% completion rate). The survey introduced members to the origin of Pernkopf's atlas and asked for the surgical utility and recommendation on the ethical handling of this atlas. This involved the development of a four-point proposal to address current issues as the response from nerve surgeons in part of a multi-institutional effort for its ethical handling. This proposal includes (1) a formal disclosure, (2) consensus from the bioethical community, (3) consensus from Bet Din (Jewish religious rabbinical court) for preserving human life, and (4) establishing an official memorial for the victims of the atlas.
Results
Fifty-eight percent (58.7%) of respondents were aware of Pernkopf's atlas with 19.3% currently using it. Of those that were aware, 75.0% were conscious of its historical origin. Respondents identified Pernkopf's atlas as having greater anatomical detail (range 78.8-90.6%) and surgical utility (range 64.4-80.8%) when compared with Netter's anatomical atlas (p < .003). Following a factual explanation of the history surrounding the atlas, 66.0% felt comfortable using the atlas as reference material, 17.3% undecided, and 16.7% uncomfortable. Following the four-point proposal for the ethical handling of the atlas, 65.5% would use the atlas, 28.5% would use it regardless of the proposal, and 6.1% would not use it.
Conclusion
While a majority of nerve surgeons are aware of the historical origin of Pernkopf's atlas, there still exists a division in opinion on whether this detailed, yet controversial, atlas could be used to benefit the lives of patients.
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