A Reconsideration of Library Treatment of Ethically Questionable Medical Texts

The Case of The Pernkopf Atlas of Anatomy

Laurel Scheinfeld, Jamie Saragossi, and Kathleen Kasten-Mutkus

Laurel Scheinfeld (laurel.scheinfeld@stonybrook.edu) is a Health Sciences Librarian at Stony Brook University Libraries. Jamie Saragossi (jamie.saragossi@stonybrook.edu) is the Head of the Health Sciences Library at Stony Brook University. Kathleen Kasten-Mutkus (kathleen.kasten@stonybrook.edu) is Head of Humanities and Social Sciences at Stony Brook University Libraries.

Manuscript submitted June 1, 2020; returned to authors for revision July 28, 2020; revised manuscript submitted September 14, 2020; accepted for publication September 23, 2020.

The Pernkopf Atlas of Anatomy consists of anatomical drawings created by Austrian physician Eduard Pernkopf, an active member of the Nazi Party during World War II. While the book was known for its highly detailed anatomical drawings, in the 1990s it was determined that Holocaust victims were likely used as subjects for the drawings. Using a survey, the authors aimed to gather information about the presence of this monograph in academic libraries today to provide best practice recommendations for academic libraries in their approach to ethically questionable materials.

It is not possible or even desirable for all items in a library’s collection to be free of controversy. Well-developed collections contain diverse subject material that represents various points of view conditioned by different historical, cultural, and intellectual perspectives. It is also unrealistic to expect librarians who manage collections to be aware of all the controversial elements of every item in the collection or all ethical breaches committed by creators of the material. When an egregious breach of ethics has been committed during the creation of a text, and a large body of literature has been devoted to discussion of the breach, do libraries have a role to play in providing contextual information about these texts to patrons who may be unaware so they may make their own determinations about whether and how to use the resource?

The authors recently engaged in discussion about the controversies surrounding The Atlas of Topographical and Applied Human Anatomy, often referred to as The Pernkopf Atlas (The Atlas), with a researcher at their institution. The Atlas is named after its creator, Eduard Pernkopf, who was an active member of the Nazi party during the Third Reich.1 Nazi symbols are incorporated into signatures on individual illustrations in the Atlas. Though these facts are extremely distasteful, censorship of distasteful material is not part of the mission of libraries. What makes The Atlas a work of which libraries should be aware is that individuals depicted in the anatomical drawings were likely victims of the Nazi regime.2 The disregard for both human life and informed medical consent has led to ongoing and evolving conversations in the medical community over whether this material, which was gathered unethically, should ever be used and under what circumstances. A recent New York Times article outlines a difficult decision and conversation surrounding medical ethics between a doctor and patient in Israel.3 The patient’s family was given the power to ultimately decide whether The Atlas should be used by the surgeon while attempting reconstructive surgery highlights the importance of shared decision making. Because of the ethical issues surrounding its production, the removal of most of the overt Nazi symbolism in later editions, and its continued status as a well-regarded resource in certain medical fields, The Pernkopf Atlas poses an ideal use-case from which to consider and build library policies with regard to controversial materials.

The Stony Brook University Health Sciences Library owns three editions of The Atlas which were available in the circulating collection when Stony Brook librarians recently became aware of this resource’s problematic origins. Although an official notice detailing an investigation into the book’s origins was drafted over twenty years ago and sent to libraries by the University of Vienna, no evidence exists of Stony Brook having received the notification or that any changes were made in the handling of the book at Stony Brook. Berry states that, according to a summary of the final report of the University of Vienna’s investigation into the matter, the information sheet was to be sent to “a representative selection of European and International libraries.”4 This research did not reveal a list of these libraries, nor a rationale for how the selections were made. Therefore, a question arose as to whether other research libraries had documentation that showed the notification had been received and if current staff are aware of it.

Along with archives and museums, libraries are often considered cultural heritage institutions. These institutions contain sensitive materials and need to make decisions on handling them in the most appropriate way. For archives and museums, mediated access is the norm and provides an opportunity for a work’s historical background to be shared with patrons. And for libraries, reserves and special collections provide one method for mediated access to materials. In 1996, the National Institutes of Health’s (NIH) library publicly shared that, after learning of the issue regarding The Atlas, they removed all editions of the book from circulation and placed them on open reserve, though no informational or educational material was attached or inserted in them. In a letter to the editor of the NIH Record, the chief librarian and the chair of the Library Advisory Committee stated, “We were persuaded that to mark the book with an acknowledgement of the controversy surrounding it would constitute a precedent for subjective judgment of any published work.”5 A recent, informal search of academic library catalogs revealed that The Atlas is widely available in circulating collections, both in health sciences libraries and general academic collections. A few libraries provided notes in their bibliographic records, providing evidence of attempts to document awareness of the controversy. However, for the vast majority of research libraries, no such note is provided for patrons. The authors wanted to learn what methods libraries have employed to document receipt of notification or to document change in location or status of the text after becoming aware of its history.

Medical information sources typically become outdated more quickly than those for other subjects, and medical librarians often deselect titles due to their age. In contrast, although the most recent edition of The Atlas was published almost forty years ago, this discussion remains timely because the work continues to be used. Newer anatomy atlases are available; however, some medical professionals continue to use and rely on this particular atlas due to its uniquely detailed drawings.6 In 2017, the Vienna Protocol, which provided guidance on the continued use of The Atlas, was published.7 Nerve surgeon Andrew Yee shares his recent experience making the decision to utilize The Atlas:

An image from this atlas was, for this surgeon, the only anatomic drawing available to navigate the complex anatomy of the saphenous nerve in this region. There was no other surgeon available with experience in this surgical exposure, and no other accessible anatomic resource that described the exposure in adequate detail.8

Due to its controversial nature, there is also risk of theft or mutilation of this text, which is another important reason for libraries to be aware of it.9 It is also important to address the potential for libraries to engage in censorship in the handling of this material by suppressing the record or removing it from the collection. The current research gathers further information about the presence and handling of this monograph at academic libraries today.

Literature Review

The scholarly literature devoted to The Pernkopf Atlas is interdisciplinary, appearing in journals in the fields of library science and the history of medicine. Beginning in the 1990s, scholars and practitioners began to question the composition of The Atlas and the possibility that its images were based on Holocaust victims. Atlas notes that Ernst published a paper in the Annals of Internal Medicine detailing the history of the University of Vienna in 1938 with a focus on Pernkopf’s work and the ethical considerations surrounding The Atlas.10 In 1996, Israel and Seidelman wrote to the editor of the Journal of the American Medical Association to call for the University of Vienna to study Pernkopf’s work to discover the identities of the individuals depicted in The Atlas.11 These questions were partially answered in 1997 when the rector’s office at the University of Vienna issued an insert entitled, “Information for Users of Pernkopf’s Atlas,” to be included with copies of The Atlas held in libraries.12 Whereas this insert acknowledges the controversy, it is inconclusive regarding the identities of the individuals in The Atlas and how their remains were obtained. The literature surrounding The Atlas grapples with the ethical and historical implications of the work, its continued use, and its presence in libraries from both historical and practical perspectives.

There are two significant library case studies in the former category. Atlas conducted a survey of libraries at member institutions in the American Association of Medical Colleges to understand how these institutions had handled Pernkopf’s The Atlas, and found that most of the sixty respondents had a copy and had relocated it to special or historical collections after learning of the controversy.13 This survey provides important background into how medical libraries have coped with the controversy surrounding The Atlas. Atlas concluded his study by addressing the fact that medical libraries often lack defined policies regarding the accession and treatment of controversial or ethically questionable materials, and that these policies would both protect libraries and allow them to signal that they are not accountable for every viewpoint expressed in their collections.14 Atlas’s work differs from the current study in an important way. The survey discussed in the current paper was distributed to libraries that are members of the Association of Research Libraries (ARL), allowing the authors to query non-medical libraries as to their treatment of The Atlas. This is critical because of the potential scholarly interest in The Atlas beyond the health sciences.

In another library case study, Mages and Lohr describe a seminar for medical students in a medical humanities program, based on The Atlas and taught by librarians.15 Students were asked to consider the ethical implications and how it should be treated by libraries. Interestingly, when students were surveyed at the end of the session, they voted to continue to provide access to The Atlas, with context, and some advocated its active promotion. This study makes a crucial contribution to the literature by highlighting library practice not just as a way of containing The Atlas, but to use its ethical failings and continuing controversy to invite students and researchers to consider the broader implications of medical ethics, and the need to approach all materials from an informationally literate, critically informed perspective.

Batoma considers The Atlas within the context of Enlightenment ideals and attempts to grapple with its ethical implications according to these principles.16 Engaging with three positions regarding The Atlas—to suppress it, to keep it in use based on its value as a work without respect to its creator, and to keep it in use with notifications meant to honor victims of Naziism—Batoma considers each within a framework of Enlightenment concepts. This project provides insight into the range of perspectives taken on The Atlas and the implications for libraries, which are in many ways inheritors of the Enlightenment tradition with the emphasis on education, empiricism, and freedom of thought.

Morrisey engaged more directly with the library profession by examining the American Library Association’s (ALA) ethical guidelines for collection development.17 He offered concrete examples for how libraries should address the acquisition of potentially controversial content and how they should make this content accessible.18

Skekel takes this discourse further by exploring library ethics related to technical services and the choices and policies that condition access to library content.19 This study makes a significant contribution to conversations regarding The Atlas in its consideration not only of library content, but of how libraries work within their mandate to provide access to thoughtfully handle problematic texts.

The medical literature devoted to The Atlas is drawn from the fields of medical history, ethics, and education.20 The interdisciplinarity of this corpus is the result of attempts to understand The Atlas’s place in the history of Nazi medicine, and as an instance in the history of medical consent and research ethics. Library decisions regarding The Atlas, plus other texts that are similarly problematic, should be informed by this scholarly apparatus. The current study rests on this work, while applying a methodology of data gathering and the use of a survey instrument.

Method

An initial phase of data gathering included using ARL’s website to identify a sample of institutions. The online catalogs for all ARL libraries (n = 124) were searched. A data capture form was established to determine: (1) if the library is a Health Sciences Library; (2) if there is a specific location listed for holdings in the library system (i.e., special collections display, storage, reference etc.); and (3) borrowing policy (if available through catalog). The libraries that were identified as holding at least one copy of The Pernkopf Atlas (n = 94) were added to a list of potential survey respondents. Contact information for administrators or those working directly with resource management and collection development within the library were added to the sheet for survey distribution. A survey was created using Qualtrics. This study was reviewed and exempted by the local institutional review board because there was no foreseeable risk to subjects. The survey contained fifteen questions intended to determine holdings, location, and borrowing policies of The Pernkopf Atlas, knowledge of the ethical concerns surrounding this text, and distribution of contextual information regarding the ethical concerns (see Appendix A to access the full survey). Each identified respondent received an email requesting participation in the survey and one follow-up email providing an extension of the survey’s closing date. The survey was open for thirty-five days. Responses were collected anonymously. An opportunity to voluntarily provide contact information at the end of the survey was included for anyone interested in being contacted for further information.

Analysis

There were fifty-nine responses to the survey, constituting a 47.5 percent response rate. Six of the surveys were returned missing significant information or were unable to confirm their holdings, and thus, were not included in the analysis. Of the fifty-three libraries that positively confirmed that they hold at least one copy of The Atlas, twenty-two identified their collections as primarily health sciences, twelve were considered special collections and archives, ten identified as general collections, and nine responded as other types of collections (see table 1).

When possible, location changes could be used as an indication that the library was aware of the ethical concerns associated with The Atlas. Eleven respondents indicated that The Atlas had been moved from its original location in their libraries. Ten respondents reported that the text was moved from a circulating collection to special collections or storage. Six were moved due to lack of space. Of these, two were moved to storage due to a lack of shelf space. The accessibility of the copies held in storage is not specified. The responses to this question show that only eight (13.5 percent) respondents could link the location change to information surrounding the ethical considerations of the text.

Eight (13.5 percent) responding libraries confirmed receipt of the University of Vienna’s letter that informed libraries about the ethical considerations when using this text. Interestingly, only three of these libraries reported moving the item due to its controversial nature. Other libraries did not respond, or did not mention that the item had been moved, though they noted that its current location was in special collections. A copy of the original letter and information sheet were offered to the authors during the course of their research. The letter is dated 1997 and was addressed to an individual who was director of the University of Buffalo’s Health Sciences Library at that time. The recipient of said letter is asked to include the information sheet in copies of The Atlas and to share it with other libraries (see Appendix B for a copy of the letter).

To evaluate the level of usage of The Atlas, each respondent was asked to report the most recent activity of any holdings of the book, including circulation or review. Eleven libraries responded that their copy had circulated within the last year. One library reported circulation within the last one to two years. Fourteen libraries reported that the item had circulated two years ago or longer. Twenty-seven libraries were unable to determine when the item had last circulated, or left this response blank (see table 2).

Usage was also assessed by asking if The Atlas is currently being used for teaching and/or research purposes. Five institutions responded “yes,” and provided descriptions of how it has been integrated into the curriculum:

“currently being used by research faculty in the Nursing School; no more details”

“The 3rd edition was on Reserves for students but I don’t have any information about the exact class”

“Graduate School of Biomedical Sciences—Introduction to Bioethics course uses this atlas as a case study”

“The atlas is used in undergraduate and medical student instruction sessions when discussing issues of ethics. It has also been used in History course on Nazi Germany”

“I sometimes use these atlases as part of a larger lesson in which anatomical atlases are examined with an eye towards asking questions about ethics, consent, etc. While pictures are normally allowed, I explain why I do not allow for photos to be taken of the Nazi imagery in these atlases”

The date and method of acquisition were sought to determine if awareness of the controversy, beginning in the early 1990s, led to any significant increase in acquisitions of The Atlas by ARL member libraries. The majority of libraries were unable to provide information on the year or method of acquisition, and therefore, a determination could not be made. Only two holdings were confirmed as being acquired after the letter was sent from the University of Vienna, and both had an undetermined method of acquisition. All five libraries that reported their holdings as donations were unable to determine the year of acquisition.

While only eight libraries could confirm receipt of the University of Vienna’s letter, sixteen libraries reported that they do in fact provide some kind of contextual information with The Atlas. Librarian or library staff curation was the most common method of providing the contextual information, followed by including the insert with the physical item. Only three institutions reported that a note is included in the bibliographic record. One respondent reported in a free text box that several copies of The Atlas have gone missing over the years. This library purchased a replacement set after the first went missing. Of that set, one of three volumes is still in the library, while the other two are noted as missing. No attempt has been made to purchase additional replacement volumes, nor is there an indication given of where these items were located prior to their disappearance. Other respondents indicated the desire for the authors to share updated recommendations based on their research (see table 3).

Findings

The Atlas is widely available in both health sciences and general collections in ARL member libraries. Usage is largely unknown. Most of the responding libraries lack evidence of receiving notification about the origins of The Atlas, and therefore do not provide contextual information to users.

The Atlas in library collections raises important questions related to information literacy that transcend the question of the behavior of individual libraries regarding this particular work. As Johns points out, the material form of the printed book as a commercial product, established by physical realities and market forces, underlies reader attitudes toward the text it contains. Reader response to the printed book is influenced by assumptions about how books are created and produced to convey and store information. These qualities do not inhere in the book itself, but rather are the product of the creation of “print culture” as we have come to know it and its investiture with qualities associated with printed texts.21 For the librarian, the knowledge that people encounter materials in libraries in ways conditioned by book culture and the materials’ selection for the library’s collections must influence decisions about access and context. In the case of The Atlas, this has been achieved through notes in the bibliographic record, physical notes placed with the volumes, and the transfer of copies to special collections or other noncirculating collections. Some institutions have used The Atlas to address the broader issues of medical ethics and information literacy.22 These practices speak to the fact that The Atlas exists as an egregious example of what is, in effect, a much broader phenomenon. No book in a library’s collection is neutral; all are the result of authorial, economic, and material realities and intents plus curatorial decisions made over time. As librarians, we have the opportunity to educate our patrons about the vital importance of approaching the information they consume— both within and outside of the library—from a critically aware, informationally literate perspective.

In 2001, Atlas called on fellow librarians to alert readers to this controversial material and recommended developing a uniformly applied system to accomplish it.23 The Vienna Protocol also encourages “making it known to one and all just exactly what these drawings are.”24 Based on the current study, only a small fraction of libraries alert the reader about this text and the methods are not transparent or consistent. It appears that this is due to lack of awareness (as is the case at Stony Brook) rather than an informed decision. This points to either an inadequate distribution of the letter by the University of Vienna, a lack of documentation of receipt of the letter by recipient institutions, or both.25

Based on this analysis, the authors share several insights with implications for library practice. The authors recommend improved documentation of dates and methods of acquisition of texts plus improved documentation to track reasons for changing location or status. The inability of several of the respondents to answer questions about the history of items in their collection illuminates the need for more detailed record keeping. Indeed, egregious cases, such as The Atlas, illustrate gaps in library practice that hinder broader and easier access to all library collections. The ability to draw larger conclusions based on the most controversial works offers libraries the benefits of interrogating their collection management processes and assumptions. This, in turn, supports research about controversial works and their role in academic library collections with implications for scholarship, teaching, and the promotion of information literacy.

Providing contextual information to users of The Pernkopf Atlas is recommended to facilitate critical analysis of the text by the end users. Based on consultation with the Cataloging and Metadata Services Department at the authors’ institution, a note was added to the MARC 59X field in the bibliographic record; the 59X is used for local notes. The specific text of the note chosen was selected from those used by ARL institutions in the authors’ sample. The text follows:

In 1996 this atlas and its author, Eduard Pernkopf, became the focus of a controversy in scientific ethics when it was discovered that a large number of the illustrations in the book were likely derived from victims of the Nazi regime from 1938 to 1945. It is, therefore, within the individual user’s ethical responsibility to decide whether, and in which way, he wishes to use this book. For additional information, refer to the following articles “Ethics and access to teaching materials in the medical library: the case of the Pernkopf atlas.” Michel C. Atlas, Bulletin of the Medical Library Association, 2001, 89(1):51-58; “Upon finding a Nazi anatomy atlas: the lessons of Nazi medicine.” Richard S. Panush, Pharos of Alpha Omeg Alpha, 1996, 59(4):18-22; “What should we do about Eduard Pernkopf’s atlas?” Garrett Riggs, Academic Medicine, 1998, 73(4):380-386; “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.” S. Hildebrandt, Clinical Anatomy, 2006, 19(2):91-100

A note that pre-dated this research can also be found in the MARC 520 Summary field in one copy of The Atlas at the authors’ institution. The Cataloging and Metadata Services Department cautioned against removing or adding notes in the 520 field as this would change the OCLC master record, and impact other institutions’ holdings. The initial review of the ARL institutions’ library catalogs reveals use of the 520 field for The Atlas at some institutions and the 59X field at others. Further research and discussion among the library community would be useful to determine whether a 520 summary note should be widely adopted. This strategy would have the benefit of creating a precedent in which libraries were not required to provide contextual notes for controversial works, but by which they would be encouraged to do so to better equip their users to work in informationally literate and ethically informed ways. The authors have chosen The Atlas as a case study precisely because of the egregiousness of the ethical issues involved in its creation. However, it is possible that other, less controversial, works would also benefit from contextual notes. Any precedent or best practice proposed to libraries should be flexible enough to accommodate this spectrum, while also respecting the practices and mission of the individual institution. While providing this information in a larger context could be challenging in terms of the ultimate subjectivity of deciding which works require contextual information, a simple note in a master record would indicate that a particular work was part of an ongoing discussion and help to position it within a historical framework. Additional methods for providing context, such as educational materials offered inside or along with the book, are also recommended as avenues for reaching patrons who may not consult the catalog, and to ensure that they have the necessary skills to analyze texts whether or not they are marked as controversial. The ARL libraries included in this survey have chosen to house the book in a variety of locations, including special collections, storage, health sciences libraries, and general collections. The book’s location and circulation status have important implications for access and potential usage. The Atlas may hold a different contextual meaning in a health sciences library than in general or special collections, in which it might support the study of medical history or ethics more readily than clinical practice. Situational meaning created by location is balanced by curatorial and cataloging decisions that provide additional context to the work. Alternate schemas may be consulted as the traditional cataloging terms may not provide accurate descriptions in culturally sensitive contexts.26

The guidelines drafted by Archives for Black Lives in Philadelphia insist that the description provided of the resource, including any contextual notes, be useful to the likely users and respectful of the multitude of possible uses of a particular work. Additionally, the guidelines address the research value of the metadata itself by proposing that institutions update their records while also maintaining the superseded data.27 The survey responses described in the current study demonstrate the need for institutional memory with regard to all works, if libraries wish to provide valuable context, and the opportunity for users to understand how the context of a particular work has evolved over time. Description should encourage access while also promoting information literacy. In the case of The Atlas, this might mean finding an equilibrium between describing the book as a clinical text and a historical resource. In either case, this must be done in a way that focuses not only on the work’s content, but also on the nature and processes of its production. This duality is at the heart of the responsible description of controversial works in research libraries, and the imperative to teach researchers to approach all works with the necessary skepticism and critical distance to view them as products and as content. This is an area in which metadata librarians, instruction librarians, and curators can work together to ensure that researchers encounter texts like this within the appropriate context and in a way that equips them to make their own decisions about how, and whether, to use them.

Encouraging and promoting use of the resource for education regarding medical ethics is recommended. Librarians may consider incorporating The Atlas into their teaching of information literacy principles, specifically the critical evaluation of materials.28 They may also have opportunities to make faculty aware of The Atlas as a teaching tool. The interdisciplinary area of medical humanities or the inclusion of humanities and arts within the medical education curriculum is deemed essential for the development of the moral and professional identity of a physician.29 Such courses would benefit from the inclusion of The Atlas as a case study. As the ethical concerns surrounding The Atlas continue to make headlines, this could be a case for instruction of future medical professionals as Mages and Lohr have demonstrated.30

The emphasis on encouraging researchers to view information for its content and through the lens of its production is embodied in the Association of College and Research Libraries (ACRL) Framework for Information Literacy for Higher Education. One frame is particularly applicable to controversial texts in research libraries. “Information Creation as a Process,” posits that:

Information in any format is produced to convey a message and is shared via a selected delivery method. The iterative processes of researching, creating, revising, and disseminating information vary, and the resulting product reflects these differences.31

Individuals working with this frame are encouraged to contemplate the decisions, actions, and practices that condition the nature of information and how it is packaged, archived, and transmitted. These conditions have implications for the epistemology of the text as researchers encounter it; a thorough grounding in information literacy, guided by a librarian, can help researchers to navigate them effectively and ethically.

Conclusion

This study is informed by one research library’s encounter with The Atlas as an ethically problematic text that is still widely used in several medical fields. By surveying libraries at Research 1 institutions that hold The Atlas in their collections, it is possible to understand how libraries responded to The Atlas as a resource, and the implications of these choices for library best practices for dealing with controversial works. Libraries have a mandate to provide access to information. However, that responsibility must be accompanied by an emphasis on context and information literacy to provide patrons with a comprehensive and ethically conscious research and learning experience. The history and continued presence of The Atlas in library collections provides a means by which to study how libraries can balance the desire to avoid censorship with the need to offer morally responsible, historically-contextualized access to all works, including those that are controversial. Certain egregious cases, like The Atlas, permit a thought experiment in which libraries can ask questions about how best to make patrons aware of the need to approach information critically. The authors propose that this can be done in a way which avoids censorship by focusing on how the information was produced, rather than simply the information itself, while helping researchers to ask questions of the work before them.

The Atlas is simultaneously unique and representative of a larger phenomenon in libraries in which no work can be read as ethically neutral. The manner in which libraries approach The Atlas and other works with ethically vexed origins help to condition the library’s larger message regarding how readers approach information and how they can encounter, evaluate, and synthesize it in responsible and thoughtful ways.

References and Notes

1. Richard S. Panush, “Nazi Origins of an Anatomy Text: The Pernkopf Atlas,” JAMA: Journal of the American Medical Association 276, no. 20 (1996): 1633-34.
2. Fred B. Charatan, “Investigation of Nazi Anatomy Textbook to Start,” BMJ: British Medical Journal 314, no. 7080 (1997): 536-36.
3. Isabel Kershner, “In Israel, Modern Medicine Grapples with Ghosts of the Third Reich,” New York Times, May 14, 2020.
4. Dawn Alexandrea Berry, “Grey Anatomy: Reconsidering the Legacy of Nazi Medicine through Eduard Pernkopf’s Topographische Anatomie Des Menschen,” (master’s thesis, University of Alberta, 2008).
5. Rich McManus, “A Tainted Classic: Anatomy Text Draws Criticism,” NIH Record 24, no. 1996 (1996): 48.
6. Sabine Hildebrandt, “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,” Clinical Anatomy 19, no. 2 (2006): 91-100.
7. Joseph A. Polak, “Vienna Protocol for When Jewish or Possibly-Jewish Human Remains Are Discovered,” Wiener Klinische Wochenschrift130 (2018): S239-S43.
8. Andrew Yee et al., “Ethical Considerations in the Use of Pernkopf’s Atlas of Anatomy: A Surgical Case Study,” Surgery 165, no. 5 (2019): 860-67.
9. Michel C. Atlas, “Ethics and Access to Teaching Materials in the Medical Library: The Case of the Pernkopf Atlas,” Bulletin of the Medical Library Association 89, no. 1 (2001): 51-58.
10. Atlas, “Ethics and Access,” 51-58; Erika Ernst, “A Leading Medical School Seriously Damaged: Vienna 1938,” Annals of Internal Medicine 122, no. 10 (1995): 789-92.
11. Howard A. Israel, “The Nazi Origins of Eduard Pernkopf’s Topographische AnatomiebDes Menschen: The Biomedical Ethical Issues,” Reference Librarian 29, no. 61-62b(1998): 131-46; William E. Seidelman, “Nuremberg Lamentation: For the Forgotten Victims of Medical Science,” BMJ: British Medical Journal 313, no. 7070 (1996): 1463-67.
12. Polak, “Vienna Protocol.”
13. Atlas, “Ethics and Access,” 51-58.
14. Atlas.
15. Keith C. Mages, and Linda A. Lohr, “Body of Evidence: Integrating Eduard Pernkopf’s Atlas into a Librarian-Led Medical Humanities Seminar,” Journal of the Medical Library Association 105, no. 2 (2017): 173-78.
16. Atoma Batoma, “Information Professionals at the Crossroads of the Enlightenment: A Critical Review of the Pernkopf Controversy,” Journal of Information Ethics 17, no. 2 (2008): 23.
17. Locke J. Morrisey, “Ethical Issues in Collection Development,” Journal of Library Administration 47, no. 3-4 (2008): 163-71.
18. Morrisey.
19. Donna Skekel, “Ethical, Unethical, or Benign: Technical Services Decisions and Access to Information,” Journal of Information Ethics 17, no. 1 (2008): 20.
20. Howard A. Israel, “The Nazi Origins of Eduard Pernkopf’s Topographische Anatomie Des Menschen: The Biomedical Ethical Issues,” The Reference Librarian 29, no. 61-62 (1998): 131-46; William E. Seidelman, “Nuremberg Lamentation: For the Forgotten Victims of Medical Science,” BMJ: British Medical Journal 313, no. 7070 (1996): 1463-67; William E. Seidelman, “The Legacy of Academic Medicine and Human Exploitation in the Third Reich,” Perspectives in Biology & Medicine 43, no. 3 (2000): 325-34; Uri Weinberg and Shmuel Reis, “The Holocaust and Medicine: A Learning Moment,” BMJ: British Medical Journal 331, no. 7518 (2005): 668-68; Karl Holubar, “The Pernkopf Story: The Austrian Perspective of 1998, 60 Years after It All Began,” Perspectives in Biology & Medicine 43, no. 3 (2000): 382-88.
21. Adrian Johns, The Nature of the Book: Print and Knowledge in the Making (Chicago: University of Chicago Press, 1998).
22. Mages and Lohr, “Body of Evidence,” 173-178; Atlas, “Ethics and Access,” 51-58.
23. Atlas, “Ethics and Access,” 51-58.
24. Polak, “Vienna Protocol.”
25. Polak.
26. Heather Lember, Suzanne Lipkin, and Richard Jung Lee, “Radical Cataloging from Words to Action,” Urban Library Journal 19, no. 1 (2013): 1-8.
27. “Statement of Principles,” Archives for Black Lives, https://archivesforblacklives.wordpress.com/, accessed September 3, 2020.
28. Mages and Lohr, “Body of Evidence,” 173-178.
29. J. Donald Boudreau and Abraham Fuks, “The Humanities in Medical Education: Ways of Knowing, Doing and Being,” Journal of Medical Humanities 36, no.4 (2015): 321-336.
30. Mages and Lohr, “Body of Evidence,” 173-178.
31. “Framework for Information Literacy for Higher Education,” Association of College and Research Libraries, www.ala.org/acrl/standards/ilframework, accessed September 3, 2020.

Appendix A

Email that accompanied the survey

Dear___________,

We are contacting you to request your participation in a research survey regarding your library’s holdings of the book Atlas of topographical and applied human anatomy by Eduard Pernkopf. Our library owns several editions of this work and it has recently come to our attention that the University of Vienna determined that some of the illustrations may be based on executed victims of political terror. There are also Nazi symbols incorporated into signatures on individual illustrations. We are investigating whether other research libraries are aware of this and if so, whether any actions have been taken such as a change to the book’s loan policy or provision of informational material to users as a result. You are receiving this survey because one or more copies of this text were listed in the library catalog of your institution during a search in July 2019. This survey is anonymous. We will not be collecting any identifying information about you or your institution, unless you voluntarily opt to provide your contact information for further follow-up. We plan to utilize the results of the survey to report on the current treatment of this text in ARL member libraries. Additionally, we hope to provide libraries with useful options for handling controversial texts in a thoughtful manner. The survey will close in two weeks on _____________. Thank you in advance for your assistance with this research.

Author Names

Institution Name

Research Consent Form that accompanied the Survey

Project Title: A reconsideration of library treatment of ethically questionable medical texts: The case of the Pernkopf Atlas of Anatomy Principal Investigator: ________________________

Co-Investigators: ____________________________

Department: University Libraries

You are being asked to be a volunteer in a research study.

Purpose

The purpose of this study is to Identify if it is necessary to redistribute previous materials regarding the ethical considerations of the Pernkopf Atlas of Anatomy. Identify common and/or best practices for informing patrons without censoring materials from a library collection. Share this information in policy development for application to Pernkopf Atlas of Anatomy as well as other ethically questionable medical texts.

Procedures

If you decide to be in this study, your part will involve: Completing a short survey about your library’s holdings of the Pernkopf Atlas of Anatomy.

Risks/Discomforts

There are no foreseeable risks or discomforts associated with your participation in this study.

Benefits

There is no direct benefit expected as a result of you being in this study.

Payment to You

You will not be paid for your participation.

Confidentiality

All the information we get about you will be not be linked to you at all. The responses to this survey are anonymous. We will do this by not writing down your name or anything else that could link you in any way to the answers you give us for our study. All the study data that we get from you will be kept locked up. If any papers and talks are given about this research, your name will not be used.

Costs to You

There is no cost for participating in this survey.

Alternatives

Your alternative to participating in this study is to choose not to participate.

Your Rights as a Research Subject

Your participation in this study is voluntary. You do not have to be in this study if you don’t want to be. You have the right to change your mind and leave the study at any time without giving any reason, and without penalty. Any new information that may make you change your mind about being in this study will be given to you. You may print a copy of this consent form. You do not lose any of your legal rights by completing this survey.

Questions about the Study or Your Rights as a Research Subject

If you have any questions, concerns, or complaints about the study, you may contact _______________

at telephone # _____________

If you have any questions about your rights as a research subject or if you would like to obtain information or offer input, you may contact the ___________University Research Subject Advocate, _______________OR by e-mail, _______________

Visit _________University’s Community Outreach page, http://research.________________ overview-of-volunteering-in-research for more information about participating in research, frequently asked questions, and an opportunity to provide feedback, comments, or ask questions related to your experience as a research subject.

If you complete the following survey, it means that you have read (or have had read to you) the information given in this consent form, and you would like to be a volunteer in this study.

Survey

Can you confirm that your library currently holds a copy of any edition of Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy?

Yes (1)

Unable to determine (2)

No (3)

Skip To: End of Block If Can you confirm that your library currently holds a copy of any edition of Eduard Pernkopf’s Atlas... = No

Please describe the primary nature of your collection.

Health Sciences Collection (1)

Special Collection/Archive (2)

General (3)

Other (4) __________________________________

Where are your holding(s) currently located? If multiple copies/editions exist, please select all that apply.

Circulation (1)

Reference (2)

Special Collections (3)

Storage (4)

Other (5)

Was this the item’s original location?

Yes (1)

No (2)

Not sure (3)

Display This Question: If “Was this the item’s original location?” = No

What was the item’s original location?

____________________________________________

____________________________________________

____________________________________________

____________________________________________

Please briefly describe the rationale of the location selected for this item (i.e.- storage due tolack of space)

____________________________________________

____________________________________________

____________________________________________

____________________________________________

When was the most recent activity (viewing, circulation, request) associated with this item? If multiple copies/editions exist, please select the most recent.

within the last 6 months (1)

6 months - 1 year (2)

1-2 years (3)

2+ years (4)

unable to determine (5)

Please provide the acquisition method for this item. If multiple copies/editions exist, please select all that apply.

donation/gift (1)

purchase (2)

part of a large scale or package purchase (3)

unable to determine (4)

Please provide the year of acquisition for this title if available, if multiple copies/editions exist please separate each date entry with a comma: (i.e. 1992, 2002)

____________________________________________

Are you aware of this atlas being used for any specific teaching and/or research purposes at

this time?

Yes (1)

No (2)

Skip To: Q12 If “Are you aware of this atlas being used for any specific teaching and/or research purposes at this…” = No

To the best of your ability, please briefly describe the nature of the course and/or research project currently using the atlas?

____________________________________________

____________________________________________

Do you have any evidence of your library ever having received the information sheet from the University of Vienna titled ‘Information for the Users of the Pernkopf Atlas’

yes (1)

no (2)

Does your library provide any contextual information to accompany the atlas? Please select all that apply:

note in the catalog record (1)

link to background information via discovery layer or catalog (2)

insert to accompany physical item in the collection (3)

librarian or library staff curation (4)

other (5) __________________________________

Is there anything else you would like to tell us about your library’s holding of the atlas?

Yes (1) ____________________________________

No (2)

Would you be willing to further discuss the holding information and details of Pernkopf Atlas of Topographical and Applied Human Anatomy?

yes (1)

no (2)

Skip To: End of Survey If “Would you be willing to further discuss the holding information and details of Pernkopf Atlas o…” = no

Please provide your email address and/or phone number for follow up: ____________________________________

Appendix B