The Pernkopf atlas is a well-known case study of anatomists' ethical transgressions in using bodies of Nazi victims for professional purposes and the relevance of this history for today. This study examines the likely sources from which Pernkopf developed his own anatomical gaze and pedagogical approach to depicting the human body. It also describes how he inserted himself in the process of creating images from human bodies, including those of executed Nazi victims. Eyewitness accounts allow a reconstruction of the workflow and an understanding of others involved, including morgue technicians, anatomists, work-study students, and illustrators. Also, it appears likely from these accounts that more bodies were needed than the number of 400 images created during the war years suggests, as often several copies of the same dissection, and thus several bodies, were needed for the painting of one image. An analysis of these processes is relevant as Pernkopf was not alone in his use of Nazi victims for anatomical representations. A study of his approach and processes may also shed light on the creation of other 20th century anatomical works from Nazi Germany and its annexed or occupied territories. Notably, the Spanner-Spalteholz atlas has a similar history of ethical transgressions, and the procedural steps identified here for the Pernkopf atlas may inform further studies of the Spanner-Spalteholz history. Going forward, these historical analyses can contribute to the development of history-informed and ethically grounded principles in the creation of innovative anatomical images, especially within emerging new technologies.