When nerve operated doctor Dr Susan Mackinnon needed assist to end up an operation, she reached, as she frequently does, for a mid-20th Century publication of anatomy.

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Thanks to the complex hand-drawn illustrations - reflecting the human body peeled earlier layer by class - Dr Mackinnon, indigenous Washington university in St Louis, was able to complete the procedure.


The publication she had actually used, the innocuous-sounding Pernkopf Topographic Anatomy that Man, is widely considered to be the ideal example that anatomical drawings in the world. The is richer in information and much more vivid in colour than any other.


Skin, muscle, tendons, nerves, organs and also bone room revealed in graphics detail. It's not for the faint-hearted.


But the book, regularly referred to together Pernkopf's Atlas, is no longer in print and a second-hand set - there are number of volumes - have the right to sell for countless pounds online.


That's since the book's findings came from the body of hundreds of civilization killed by the Nazis. The is their bodies - reduced up and also dissected - that are shown across thousands that pages.


Critics say the publication is tainted by its dark past and also scientists have actually grappled v the ethics affiliated in its use.


Dr Mackinnon says she feeling uncomfortable through its origin, yet using the book is a crucial part of being an "ethical surgeon" - and that she can not execute her task without it.


Rabbi Joseph Polak - a Holocaust survivor and professor of health law - believes the publication is a "moral enigma" due to the fact that it is obtained from "real evil, however can be provided in the company of good".


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Image source, Keiligh Baker

The publication was a 20-year job of a significant Nazi and doctor, Eduard Pernkopf, who climbed through the scholastic ranks in Austria many thanks to his support for Adolf Hitler's party.


His colleagues described him together an "ardent" nationwide Socialist who, native 1938, wore a Nazi uniform to job-related every day.


When he to be made dean of the clinical school in ~ the university of Vienna, he sacked all the Jewish members that the faculty, including three Nobel laureates.


In 1939, a brand-new Third Reich regulation ensured the body of every executed detainees were instantly sent to the nearest department of anatomy because that research and teaching purposes.


During this duration Pernkopf functioned 18-hour work dissecting corpses, if a team of artists produced images because that his book. Periodically the anatomy institute was so full, executions had actually to be postponed.


Dr Sabine Hildebrandt, native Harvard clinical School, states at least half of the 800 pictures in the atlas come from politics prisoners. They included gay men and lesbians, gypsies, politics dissidents and also Jews.


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Image source, None

In the an initial edition the the atlas, released in 1937, the signatures of illustrators Erich Lepier and Karl Endtresser consisted of swastikas and the twin lightning bolt insignia that the SS.


Even the 1964 two-volume English language edition had the initial signatures consisting of the Nazi symbols. Later editions airbrushed out the Nazi insignia.


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Image source, Erich Lepier

Thousands of copies of the atlas were sold throughout the world, and it was interpreted into 5 languages. Prefaces and also introductions in the publications describe "pictorially impressive drawings... And also outstanding pieces of art" if eschewing any mention of your bloody past.


It was only in the 1990s that students and also academics really began questioning that the world in the atlas were. After the brutal history was revealed, the atlas went the end of publishing in 1994.


The royal College of Surgeons states the atlas is no in usage in the UK, except being retained by libraries for historical purposes.


However a current Neurosurgery inspection of nerve surgeons found 59% were aware of Pernkopf's Atlas, with 13% right now using it.


Of those surveyed, 69% stated they were comfortable making use of the atlas as soon as they were made mindful of its history, 15% were uncomfortable and also 17% were undecided.


Dr Mackinnon states nothing rather "even begins to compare" come the book's accuracy and detail, and also it is particularly useful for complex surgeries because it helps she "figure the end which that the many small nerves that course v our body room potentially causing the pain".


"When ns became aware of the tainted and evil origin of this atlas I began keeping it secured away in my operation room locker," she says.


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Image source, Washington University/ St. Louis

Last year, Rabbi Polak and medical historian and also psychiatrist Professor Michael Grodin, ready a Responsum (a academic answer based on Jewish medical ethics) on even if it is it is ethical to use the atlas based on Dr Mackinnon's experience.


They concluded that most Jewish authorities would permit the usage of the photos to save person lives - under the condition the background of the atlas was made known, so the victims were afforded few of the dignity they are owed.


Rabbi Polak, told the inter-base.net: "Look in ~ Dr Mackinnon - she couldn't discover a nerve and also she's the greatest in she field. The patient told she 'I desire my leg cut off if friend can't find it' - no one wants that come happen.


"So she swallowed hard and also asked castle to bring Pernkopf's atlas. She discovered the nerve in minutes since of these illustrations.


"She request me, together a moral thinker, around the situation. And I said to her, if this is walking to cure this person and give them their life back, then there is no concern that the atlas deserve to be used."


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Image source, Washington University/ St. Louis

Pernkopf to be arrested after ~ the war and sacked from the university. That was held at one Allied jail of battle camp for 3 years yet was never charged with any kind of crime.


Following his relax he returned to the university and continued his work-related on the atlas, posting a 3rd volume in 1952. He passed away in 1955, shortly prior to the publication of a fourth volume.


More 보다 60 year later, the atlas is still one of the ideal resources for visual details for comprehensive anatomical and also surgical work, according to Dr Hildebrandt, that teaches anatomy.


"Those of us who have learned come 'see' with it use it whenever we have questions. In peripheral nerve surgical treatment some surgeons find it to it is in a unique and irreplaceable resource of information," she says.


But, she adds: "I personally perform not use the Pernkopf pictures in mine anatomy teaching uneven I have actually time come speak about its history."


Dr Jonathan Ives, a bioethicist native the college of Bristol, agrees the atlas is "amazingly detailed" but says it is tainted by its "horrific past".

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"But you could additionally argue the in not utilizing it, the atlas would be lost and also it can not be provided as a reminder of what happened."


"I would certainly think that as an moral surgeon I would certainly take it as a provided that I have to use everything educational resource I assumed would assist me to maximise a effective outcome," she says, "and the my patient would expect that that me.