Sabine Hildebrandt

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.

Anatomy in the Third Reich: An outline, part 2. Bodies for anatomy and related medical disciplines

All anatomical departments of German universities used bodies of the executed and other victims of the National Socialist (NS) regime for their work. Many of these victims had been executed in prisons and were members of the German political opposition; others had perished in camps for prisoners of war or forced laborers and concentration camps, and were of various European and other descent. Anatomists generally welcomed the increased influx of “fresh material” for purposes of research and education of the growing numbers of medical students. No anatomist is known to have refused work with the bodies of NS victims. Other medical disciplines also made use of these bodies, among them were racial hygienists and neuropathologists. In the late 19th and early 20th century, the fields of anatomy, physical anthropology, and racial hygiene (eugenics) were closely related in their subject matter. Anatomists were involved in the biological foundation of racial hygiene, most prominently among them Eugen Fischer. The discipline was established as part of the medical curriculum after 1920. Racial hygiene became the scientific justification for NS policies that led to racial discrimination, involuntary sterilization and ultimately mass murder. Anatomists taught racial hygiene throughout the Third Reich and did research in this area. Some were actively involved in NS policies through propaganda and evaluations for the so‐called Genetic Health Courts, whereas others became victims of their own science in that they were dismissed for racial reasons. 22:894–905, 2009.

Autoantibodies to topoisomerase I (Scl-70) : analysis by gel diffusion, immunoblot, and enzyme-linked immunosorbent assay

Anti-topoisomerase I autoantibodies (anti-topo I, anti-Scl-70) are associated with proximal scleroderma and are of prognostic significance in patients with Raynauds disease. To establish a highly sensitive and specific system for the detection of anti-topo I, we have investigated sera from 409 patients and controls by Ouchterlony gel diffusion, Western immunoblot on chromosome proteins, and solid-phase enzyme-linked immunosorbent assay (ELISA) with purified topoisomerase I as antigen. The ELISA was more sensitive than the gel diffusion technique and was more specific than the Western immunoblot, while the immunoblot may identify additional autoantibodies.

A long-term longitudinal isotypic study of anti-topoisomerase I autoantibodies.

SummaryIn this first retrospective longitudinal study of anti-topoisomerase I autoantibodies (anti-topo I) we examined the isotypic expression in 13 patients with scleroderma by enzyme-linked immunosorbent assay. Titers were stable for up to 16 years. However, one patient lost the antibody, while another developed high levels of IgM with myositis and another, high levels of IgA with cardiac disease. For the first time the de novo development of anti-topo I was observed.

The willed body donor interview project: medical student and donor expectations.

The Anatomical Donations Program at the University of Michigan Medical School (UMMS) has begun a multiphase project wherein interviews of donors will be recorded and later shown to medical students who participate in the anatomical dissection course. The first phase of this project included surveys of both current UMMS medical students and donors concerning their perceptions of such a program. A five‐question survey administered via Qualtrics software was electronically mailed to all current medical students at UMMS, and a survey was mailed to registered and potential donors requesting information from the UMMS on anatomical donations. A total of 224 medical student responses (response rate 33%) and 54 donor responses (response rate 27%) were received. Seventy‐four percent of students and 81% of donors reported they would participate in this program if it existed. Students and donors supported the implementation of this program for varying reasons, though many felt strongly they would not want to participate in a donor interview program. These qualitative results support those of previous studies that show a majority of students desire a closer personal relationship with the donor, and these are the first results to be reported on donor perceptions of a donor interview program. Although many students and donors are in favor of instituting this program, others feel strongly that such an experience could be traumatic. The causes of these differing reactions need to be further explored, and the opinions of those who object to this study will be respected by maintaining voluntary participation in future phases of this study. Anat Sci Educ 6: 90–100.

Anatomy in the Third Reich.

On October 29, 2010, a public symposium was held on the topic f anatomy in the Third Reich in Würzburg, Germany (Pringle, 010; Hildebrandt, 2011). The symposium was the first meeting n this topic organized under the auspices of the Anatomishe Gesellschaft, an international anatomical society founded in ermany in 1886. The present special issue of Annals of Anatomy ontains the proceedings of almost all of the symposium contribuions. The purpose of the symposium was – as for every scientific eeting – to bring together specialists in this field of research, to xchange information and to initiate future research projects. The nformation provided at the conference and in this issue may also timulate anatomists in Germany and Austria to study the history f their institutions. German anatomists have investigated this period of their history n the past, for example, at the universities of Bonn, Berlin, Gießen, öttingen, Halle, Hamburg, Heidelberg, Jena, Marburg and Tübinen. Shortly before the symposium, the current status of research n the field was summarized in a series of papers published by the uthor S.H. in the journal Clinical Anatomy (Hildebrandt, 2009a,b,c). his series of papers as well as a suggestion by Prof. William Seielman, emeritus professor at the University of Toronto, prompted uthor C.R. to propose to the Anatomische Gesellschaft to orgaize a symposium on the topic, an idea that was enthusiastically ndorsed by the leadership of the Anatomische Gesellschaft. The year 2011 marks the 125th anniversary of the founding of he Anatomische Gesellschaft. The Festschrift (“celebration issue”) or this event will include a chapter on anatomy in the Third Reich Hildebrandt and Aumüller, in press) that will, for the first time, fficially acknowledge and honor the two groups of persons who ecame victims within the realm of anatomy in National Socialism NS): firstly, the persons who died as a result of NS injustice and ere dissected in the anatomical departments, and secondly, the cholars of anatomy whose careers were disrupted by NS policies.

Thoughts on practical core elements of an ethical anatomical education.

While questions of ethics in body procurement have become a focus of attention in many medical schools around the world, the recent report by a medical student regarding disturbing incidences in an anatomical dissection course (Terry, ) underlines the importance of a discussion of ethical practices in anatomical education. Here thoughts on core elements of instruction are proposed which are based on the premise that both, ethical body procurement and ethical anatomical education, are the foundation for a humanism‐based professional training of students in medicine. As the anatomical dissection course presents an exceptional situation for students, practical guidelines for a curriculum founded on ethical considerations are essential. They include a preparatory phase before the start of the course in which students are asked about their expectations and fears concerning anatomical dissection; an introduction to the history and ethics of anatomy; a time for reflection in the dissection room before the start of dissection; a regular opportunity for reflections on dissection in parallel to the course with students and faculty; and a memorial service for the donors organized by students for faculty, students and donor families. Finally, anatomical faculty should undergo training in ethical educational practices. Many anatomy programs have incorporated various of these ideas, while others have not done so. Guidelines for ethical anatomical practices can strengthen the foundation of a humanistic approach to medicine in future physicians and health care workers. Clin. Anat. 29:37–45, 2016.

The incompatibility of the use of unclaimed bodies with ethical anatomical education in the United States

Recent media attention has again drawn attention to important ethical and policy questions surrounding anatomical body procurement (Terry, 2014; Bernstein 2016a,b,c,d,e; Binkley 2016; Boburg, 2016). In a series of articles, the New York Times has shared the troubling story of the way in which anatomical body procurement was practiced at specific medical schools across the New York area in the last few years (Bernstein, 2016a,b,c,d,e). It was revealed that anatomical programs used unclaimed bodies, and that after use at one medical school the bodies of donors were placed in a mass grave against their wishes (Bernstein, 2016b). While controversies surrounding the practices of anatomy are as old as the history of this basic medical science itself, faculty and students of anatomy have more recently focused on revisiting foundational aspects of the discipline in an effort to formulate core principles for ethical practices of modern anatomy as a key to medical professionalism (Tubbs and Jones, 2016). These constitute a reframing of the relationships between anatomical educators, students, and body donors, using a variety of educational and procedural approaches. Among them are courses for the emotional preparation of students for the dissection course, reflection sessions during the course, memorial services for donors, deanonymization of donors, and student contact with donors and their families (compare recent reviews in: B€ ockers, 2015; Hildebrandt, 2016). Specifically, the new conceptualization of anatomy includes the ethical care for anatomical bodies and the focus on respect for and dignity of the body donor (Champney, 2011). Under this premise, the use of unclaimed bodies, that is: of persons who themselves or their families have not consented to the use of their bodies for anatomical purposes, is considered unethical, especially when bodies from body donation programs are available in sufficient numbers (Jones and Whitaker, 2012). In the United States, the vast majority of anatomy programs have been fortunate to participate in the significant change from using bodies of unknown provenance to a robust donation system, in which bodies are obtained only from consenting living donors and their families. This transformation of the anatomical body supply occurred gradually throughout the second half of the 20th century, and among the driving forces were changes in the public perception of medicine, in the funeral industry, and in legislation (Garment et al., 2007). In 1998, a survey of anatomy programs in the United States and Canada found that less than 20% used unclaimed bodies (Dasgupta, 2004). Since then, body donations have steadily risen, but some schools still use unclaimed bodies (Binkley, 2016). However, many anatomists in the United States and elsewhere firmly believe that bodies from individuals who have not consented should not be used (Champney, 2011; O’Reilly, 2011; FICEM, 2012; Jones and Whitaker, 2012; Riederer and Bueno-L opez, 2014). Therefore, unclaimed or unidentified bodies would not be acceptable for use in medical education. The new model for anatomy is indeed based on the recognition that anatomical dissection is only made possible through the selfless gift of another human being to the anatomist and student (Hildebrandt, 2016; Riederer, 2016). With this acknowledgement, the anatomist and student are called to honor the individual who has made the gift in a dual manner: by using the donor’s body for the careful study of anatomy, and by allowing the donor’s body to serve as the focus of interpersonal relationships in life and death, to advance the humanistic culture of caring for those involved with the dissection, and inculcating the values of compassion, selflessness, kindness, and empathy within the practice of medicine (see e.g., Winkelmann and G€ uldner, 2004; Pawlina, 2006; Lin et al., 2009; Pawlina et al., 2011; B€ ockers, 2015). To do so, theoretical considerations have been formulated, and curricular materials developed and implemented, in an effort to instill a focus on humanism and personal development in addition to the required curricular content on the structure of the human body (Hildebrandt et al., 2016; Kahn and Gardin, 2016). This new orientation allows the dissection course to establish a well-balanced approach to a confrontation with disease, death, and dying in the safe space of the anatomy laboratories (Hildebrandt, 2016). These efforts indicate a paradigm shift, in which anatomical education is no longer purely a purveyor of knowledge on the structure and function of the human body, but is also focused on the ethical underpinnings of the discipline (Pawlina and Drake, 2016). Programs which continue to use unclaimed bodies, despite the availability of consented donor bodies, preclude their students from the opportunities that this new model of anatomy offers. With these latest revelations of abusive practices in anatomical body procurement (Bernstein 2016a,b,c,d,e; Binkley, 2016; Boburg, 2016), anatomy programs should commit *Correspondence to: Dr. Sabine Hildebrandt, Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Harvard Medical School, 333 Longwood Avenue, LO 234, Boston, Massachusetts 02115. USA. E-mail: sabine.hildebrandt@ childrens.harvard.edu

Public Health in the Vilna Ghetto as a Form of Jewish Resistance

We describe the system of public health that evolved in the Vilna Ghetto as an illustrative example of Jewish innovation and achievement during the Holocaust. Furthermore, we argue that by cultivating a sophisticated system of public health, the ghetto inmates enacted a powerful form of Jewish resistance, directly thwarting the intention of the Nazis to eliminate the inhabitants by starvation, epidemic, and exposure. In doing so, we aim to highlight applicable lessons for the broader public health literature. We hope that this unique story may gain its rightful place in the history of public health as an insightful case study of creative and progressive solutions to universal health problems in one of the most challenging environments imaginable.

Idiotypic Analysis of Human Anticentromere Autoantibodies

The idiotypes (Ids) of anticentromere antibodies (ACA) have been studied using a fusion protein obtained from cloned cDNA of the major centromere antigen, CENP-B, for isolation of the autoantibodies. IgG-ACA were affinity purified from 4 patient sera and anti-Ids prepared in rabbits. Analysis revealed the existence of two distinct types of immunodominant Ids. One Id is near the antibody combining site and one is framework associated. A longterm longitudinal study of Id expression in a patient who seroconverted from ACA (-) to ACA (+) when she developed Raynauds phenomenon showed a close correlation between Id expression and ACA titers (r = 0.94). These results may be interpreted as evidence for an autoantigen driven process in the anticentromere immune response.