Every day before they go into surgery, doctors around the world consult their Pernkopf anatomical atlas to make sure they'll remember exactly where everything inside their patients is.
Medical illustrators keep the Pernkopf Anatomy on their drawing boards for ready reference as they depict obscure internal organs with computer-generated images. Newer atlases of the human body incorporate images painted decades ago for the Pernkopf atlas, considered the greatest collection of anatomical paintings ever created.
David J. Williams, professor and director of medical illustration at Purdue University, calls Pernkopf's seven-volume "Topographische Anatomie des Menschen" ("Topographical Anatomy of Man") "the standard by which all other illustrated anatomical works are measured."
"They're masterpieces," says Williams. "Monumental."
But 50 years after their initial publication, the Pernkopf illustrations have come under fire, igniting debate in the medical community. Many people now believe that Eduard Pernkopf, the Austrian anatomist for whom the atlas is named, and his team of artists used specimens harvested from victims of Nazi concentration camps for their illustrations.
Pernkopf, who formed the team that created the atlas, was a virulent Nazi who, during his term as dean of medicine at the University of Vienna, purged his faculty of Jews and other "non-Aryans." His core group of artists also were Nazis. They signed some of their illustrations with swastikas and the double lightning bolt insignia of the SS, the vicious Schutzstaffel who were the praetorian guard of the Holocaust.
So, half a century after the Holocaust, the Pernkopf Anatomy once again has raised the question of whether bad people can do good works. Earlier this week in Baltimore, a distinguished panel of experts explored the problem of such "tainted" information at the annual meeting of the Association of Medical Illustrators.
Opinions were strong, but the debaters remained sharply divided at the end of the day.
"Reactions to these revelations," said Purdue's Williams, "range from demands for complete removal of Pernkopf's atlas from the medical (literature) to recognition of the reality that it is still used by surgeons and anatomists who are used to its great detail and admire its beautiful art."
Dr. Howard Spiro, a gastroenterologist from Yale University who has written about experiments on Gypsies by Nazi doctors, said he believes the former. "I honestly and truly believe we should not use this data," he said.
"When you say some good can come out of (tainted) data, it seems to me we tell our children and grandchildren the end justifies the means. I am very much against using any (such) data any way at all."
Williams observed that Nazi science has been an issue since the end of the Nazi regime in 1945.
"Some would abolish everything from the Nazi era," he said. "Others argue that it should be used to honor those who suffered."
Williams is probably the single most knowledgeable expert on the Pernkopf Anatomy. In 1980, he studied with Franz Batke, the last surviving Pernkopf painter.
"I didn't know he was a Nazi when I went," Williams says. "I admired the man immensely. I remember that I was crushed - that the man I considered a genius had been a Nazi."
Williams told him that Americans had raised the possibility that the cadavers of concentration camp victims were dissected for the atlas.
"He was very upset about this," Williams says. "Of course, he denied it. But he was upset."
Williams essentially started the debate when he gave a paper on the atlas at the 30th International Congress for the History of Medicine in Dusseldorf, Germany, in 1986. He has since lectured widely on the Pernkopf Anatomy, recently at a conference in England at Cambridge University,
Pernkopf, Williams says, was a world-renowned anatomist at the University of Vienna in an era when an anatomist cemented his reputation by producing an atlas. He signed the contract to produce his atlas in 1930.
He was also a lifelong German nationalist and anti-Semite who joined the Nazi party secretly in 1933. Pernkopf was named dean of the University of Vienna medical faculty four days after German Nazis marched into Vienna on March 15, 1938, to annex Austria to Hitler's Third Reich.
Pernkopf was dressed in his storm trooper uniform and stood before a portrait of Hitler and was flanked by swastikas when he gave his first speech in his new post, receiving the stiff-armed "sieg-Heil" salute of his colleagues.
He immediately purged all "non-Aryans," or Jews, on the medical faculty. From a faculty of 197, 153 people were dismissed.
About 100 of those purged emigrated, many to the United States. At least seven died in concentration camps, Williams says. Four committed suicide in 1938, according to another source. The fate of nine others remains unclear. The medical faculty at the university, perhaps the greatest in the world at the time, was destroyed and has never regained its pre-Nazi eminence.
The Nazis rewarded Pernkopf in 1943 by making him rektor magnificus, "president" of the university, a post that until then always had been filled by vote of colleagues.
World War II interrupted work on the atlas. And after the Allied victory, although he was never charged with war crimes, Pernkopf served three years at hard labor in a prison camp.
He returned to Vienna a broken and dispirited man, according to Williams. But he was able to reassemble much of his old team to complete the final volumes of his work.
Williams doubts that any Jewish concentration camp victims were used in Pernkopf illustrations. Many cadavers came to the medical school from the Vienna court systems: Austrian patriots, communists and others ordered executed by the Nazi-dominated courts. But so far, no direct link has been made between any of these corpses and the Pernkopf anatomy.
The University of Vienna recently has begun its own investigation.
In an odd turn of commercial fate, Waverly Inc., the Baltimore medical book publishers, became owners of the atlas in 1990 when it acquired the German publishing house Urban and Schwarzenberg.
Waverly chief executive officer Edward Hutton, who joined the panel at the illustrators' meeting, says the English-language edition of the Pernkopf is virtually out of print. But about 200 copies are sold each year in Germany. Each now carries a cautious disclaimer that Eduard Pernkopf's Nazism and anti-Semitism "cast a shadow on this book."
Even before the recent controversy, the Pernkopf atlas had been sanitized over the years. The signature swastikas and SS lightning bolts of some illustrations, for example, have been airbrushed out.
And where the first editions contained vast tracts of text, the Pernkopf Anatomy is essentially a detailed picture book, reproducing what many see as indisputably great works of medical art.
If the University of Vienna finds that Nazi victims were used in preparations for the illustrations, Hutton says, they would be honored with a suitable commemoration in future editions.
"Until then," as the disclaimer now says, "it remains the decision of every user as to how to confront this atlas."