Chapter 18

THE FINAL PHASE: EXPERIMENTATION ON MAN

There is one phase of scientific research which cannot be passed in silence. It is experimentation upon human beings. That "no experiments on animals are absolutely satisfactory unless confirmed upon man himself," a well-known vivisector has asserted; and no one acquainted with the trend of events, could doubt the coming of a time when opportunity for such "confirmation" would be given, and when a more precious and a less costly "material" than domestic animals would be used for investigations of this kind. Writing many years ago, a distinguished jurist declared that "to whomsoever in the cause of Science, the agony of a dying rabbit is of no consequence, it is likely that the old or worthless man will soon be a thing which in the cause of learning, may well be sacrificed."

It is necessary at the outset, however, to draw a careful distinction between those phases of experimentation upon man which seem to be legitimate and right, and those other pases of inquiry which are clearly immoral. It is, of course, to be expected that certain experimenters upon human being will endeavour to confound both phases of inquiry in the public estimation; and yet there is no difficulty in drawing clear distinctions between them. Let us see what differences may be perceived between the experimentation upon human beings which is laudable and right, and the other phase of inquiry which Society should condemn.

I. Any intelligently devised experiment upon an adult human being, conscientiously performed by a responsible physician or surgeon solely for the personal benefit of the individual upon whom it is made, and, if practicable, with his consent, would seem to be legitimate and right. In the practice of medicine, there must always be a "first time" when a new method of medical treatment is tested, a new operation performed, a new remedy employed. Whether the procedure pertain to medicine or surgery, so long as the amelioration of the patient is the one purpose kept in view, IT IS LEGITIMATE TREATMENT. The motive determines the morality of the act.

II. Now human vivisection is something quite different. It has been defined as "the practice of subjecting to experimentation human beings--men, women, or children, usually inmates of public institutions--by methods liable to involve pain, distress, injury to health, or even danger to life, without any full, intelligent, personal consent, FOR NO OBJECT RELATING TO THEIR INDIVIDUAL BENEFIT, BUT FOR THE PROSECUTION OF SOME SCIENTIFIC INQUIRY."

The distinction is a perfectly clear one. Under the term "human vivisection" only those experiments are included which have some of these characteristics:

1. THE OBJECT IS SCIENTIFIC INVESTIGATION, AND NOT THE PERSONAL WELFARE OR AMELIORATION OF THE INDIVIDUAL UPON WHOM THE EXPERIMENT IS MADE.

2. The experiment is liable to cause some degree of pain, discomfort, distress, or injury to the health, or danger to the life of the person upon whom it is performed. The defence often made that no real injury resulted from the experiment, cannot palliate the offence against personal rights.

3. The experiment is performed without the intelligent, and full consent of the individual experimented upon. Such legal consent of course is impossible to obtain from children, from the feeble-minded, or from lunatics in public institutions.

It is the purpose of this chapter to demonstratte that such experiments upon human beings have been performed. Naturally, it will be impossible to quote the cases in full. Enough, however, will be given to prove that the charge of human experimentation is not the exaggeration of ignorance or sentimentality; that such methods of research have been practised upon the sick, the friendless, the poor in public institutions, without their knowledge or intelligent consent; that they are in vogue even in our own time; and that hospitals and institutions, founded in many cases, for charitable purposes, have lent their influence and aid in furnishing either victims or experimenters.

Commenting upon certain human vivisections in Germany, the British Medical Journal declared in its editorial columns:

"Gross abuses in any profession should not be hushed up, but should rather bemade public as freely as possible, so as to rouse public opinion against them and thus render their repetition or spread impossible. And therefore we have reason to thank the newspaper Vorw"arts for dragging into light the experiments made by Dr. Strubell on patients.... The whole medical profession must reprobate cruelties such as these perpetrated in the name of Science."[1]

[1] British Medical Journal, July 7, 1900, p. 60.

It is this sentiment which justifies present publicity. The cases to which attention will be directed are not many; but they suffice to illustrate the practice, and to enable the reader to decide whether such experiments should meet approval or condemnation.

I. The Case of Mary Rafferty

An instance of human vivisection which ended by the death of the victim, occurred some years ago in the Good Samaritan Hospital in Cincinnati. It would be difficult to suggest a name for a hospital more suggestive of kindly consideration for the sick and unfortunate: and to this charitable institution, there came one day a poor Irish servant girl by the name of Mary Rafferty.

She was not strong, either mentally or physically. Some years before, when a child, she had fallen into an open fire, and in some way had severely burned her scalp. In the scar tissue an eroding ulcer-- possibly of the nature of cancer,--had appeared; and it had progressed so far that the covering of the brain substance had been laid bare. No cure could be expected; but with care and attention she might possibly have lived for several months. We are told that she made no complain of headache or dizziness; that she seemed "cheerful in manner," and that "she smiled easily and frequently,"--doubtless with the confidence of a child who without apprehension of evil, feels it is among friends. The accident, however, had made her good "material"; she offered opportunity for experimentation of a kind hitherto made only upon animals. "It is obvious," says the vivisector, "that it is exceedingly desirable to ascertain how far the results of experiments on the brain of animals may be employed to elucidate the functions of the human brain."[1]

[1] This case, under the significant title, "Experimental Investigations into the Functions off the Human Brain," is related at length in the American Journal of the Medical Sciences, vol. 93 (N.S., 67).

At the outset the experiments seem to have been somewhat cautiously made. Nobody knew exactly what would be the result. The experimenter began by inserting into Mary Rafferty's brain, thus exposed by disease, needle electrodes of various lengths, and connecting them with a battery. As a result, her arm was thrown out, the fingers extended, but in the brain substance no pain was felt. Presently, as the experimenter grew bolder, other phenomena appeared. The vivisector shall tell the story in his own words:

"The needle was now withdrawn from the left lobe, and passed in the same way into the (brain) substance of the right. ... When the needle entered the brain substance, SHE COMPLAINED OF ACUTE PAIN IN THE NECK. IN ORDER TO DEVELOP MORE DECIDED REACTIONS, the strength of the current was increased by drawing out the wooden cylinder one inch. When communication was made with the needles, HER COUNTENANCE EXHIBITED GREAT DISTRESS, and she began to cry. Very soon, the left hand was extended as if in the act of taking hold of some object in front of her; the arm presently was agitated with clonic spasms; her eyes became fixed with pupils widely dilated; lips were blue, and SHE FROTHED AT THE MOUTH; HER BREATHING BECAME STERTOROUS; SHE LOST CONSCIOUSNESS AND WAS VIOLENTLY CONVULSED. The convulsion lasted five minutes, and was succeeded by coma. She returned to consciousness in twenty minutes from the beginning of the attack."

The experiment was a success. Upon the body of the poor servant girl, the distinguished vivisector had produced the "violent epileptiform convulsion" which Fritsch and Hitzig and Ferrier had induced in animals, by the same method of experimentation.

There are those who feel that further vivisecting should have then ceased, and that Mary Rafferty should have been allowed to die in peace. Such views, however, were not permitted by the experimenter to interfere with his zeal for scientific research. Other "observations" were made, and the needles were again passed into the brain, evoking almost the same phenomena. The final experiments were thus described by the vivisector:[1]

"Two days subsequent to observation No. 4, Mary was brought into the electrical room with the intention to subject the posterior lobes (of the brain) to galvanic excitation. The proposed experiment was abandoned. SHE WAS PALE AND DEPRESSED; HER LIPS WERE BLUE, AND SHE HAD EVIDENT DIFFICULTY IN LOCOMOTION. She complained greatly of numbness.... On further examination, there was found to be decided PARESIS and rigidity of the muscles of the right side.... She became very pale; her eyes closed; and she was about to pass into unconsciousness, when we placed her in the recumbent posture, and Dr. S. gave her, at my request, chloroform by inhalation.

"The day after observation No. 5, MARY WAS DECIDEDLY WORSE. She remained in bed, was stupid and incoherent. In the evening she had a convulsive seizure.... AFTER THIS, SHE LAPSED INTO PROFOUND UNCONSCIOUSNESS, AND WAS FOUND TO BE COMPLETELY PARALYZED ON THE RIGHT SIDE.... The pupils were dilated and motionless."

[1] Italics not in original.

When did death come to her release? We do not know; the omission is significant; it may have been within a few moments. The next sentence in the report is headed by the ominous word, "AUTOPSY." The brain was taken out, and the track of the needles traced therein. One needle had penetrated an inch and a half. There was evidence of "INTENSE VASCULAR CONGESTION."

In cases like this, the investigation of a coroner apparently is not required. The experimenter himself was the physician to the hospital. He tells us of course that Mary's death was due to an extension of the disease, for the relief of which she had been led to the "Good Samaritan Hospital." Of the real cause of death, there was apparently but little doubt among scientific men. An English vivisector, Dr. David Ferrier, whose experiments upon monkeys had perhaps first suggested their repitition on a living human brain, questioned somewhath the propriety of the American experiments. In a letter to the London Medical Record, he referred to "the depth of penetration of the needles"; the "occurrence of epileptiform convulsions FROM THE GENERAL DIFFUSION OF THE IRRITATION WHEN THE CURRENTS WERE INTENSIFIED," and declared that the "EPILEPTIC CONVULSIONS AND ULTIMATE PARALYSIS are clearly accounted for by the inflammatory changes" thus induced.

That the experiments had been to some extent injurious to his victim, the vivisector himself, in a letter to the British Medical Journal, very cautiously admitted.[1] He regretted, he said, that the new facts which he had hoped would further the progress of Science were obtained at the expense of SOME injury to the patient. She was, however, "HOPELESSLY DISEASED,"--as if that fact tended to justify her martyrdom! "THE PATIENT CONSENTED TO HAVE THE EXPERIMENTS MADE." Is not this excuse the very height of hypocrisy? Twice, he had stated in his report of the case, that the young woman was "RATHER FEEBLE- MINDED"; he suggests that this poor, ignorant, feeble-minded servant- girl was mentally capable of giving an intelligent consent to repeated experiments upon her brain, the possible result of which even HE could not foresee!

[1] British Medical Journal, May 30, 1874, p. 727.

Who made these experiments? It was Dr. Roberts Bartholow, at that time the physician of the "Good Samaritan Hospital" in Cincinnati. His biographer says that he gained no credit "for his candour in reporting the whole affair,"--a hint, the significance of which for future experimenters, it is not very difficult ot perceive. Yet his treatment of Mary Rafferty was no bar to his professional advancement. Not long after his victim was in her grave, one of the oldest medical schools in the country,--Jefferson Medical College of Philadelphia--offered him a professor's chair; and for several years he was Dean of the medical faculty of that institution.

It might seem impossible that any physician of the present day would care to come forward in defence of this experiment. Yet forty years after the deed was perpetrated, such justification was apparently attempted in an American journal, and republished in a pamphlet issued by the American Medical Association.[1] It would seem at the outset that only by suppression of the worst facts relating to the case, could any defence be essayed. WAS THERE ANY SUCH SUPPRESSION OF MATERIAL FACTS? Let us see.

[1] "The Charge of Human Vivisection," by Richard M. Pearce, M.D., Journal of the American Medical Association, February 28, 1914.

Did any injury to Mary Rafferty result from these experiments upon her brain? Bartholow himself admits some injury; he says that to repeat the experiments "would be in the highest degree criminal." The modern apologist, however will have it otherwise. At the beginning of the experiment, she smiled as if amused; and this, he tells us, "whows that she did not object, that the pain was not severe, AND THAT NO HARM WAS DONE HER." Is this a fair summary of the symptoms elicited during these experiments upon the brain? Why did the apologist mention only the "smile," and neglect altogether to mention the other symptoms reported by Dr. Bartholow? Why does he pass in silence her complain of "ACUTE PAIN IN THE NECK," the "GREAT DISTRESS" EXHIBITED, THE ARM AGITATED WITH CLONIC SPASMS, THE FIXED EYES, THE WIDELY DILATED PUPILS, THE BLUE LIPS, THE FROTHING AT THE MOUTH, THE STERTOROUS BREATHING, THE VIOLENT CONVULSION lasting for five minutes and the succeeding unconsciousness lasting for twenty minutes? Why does the apologist leave unmentioned the symptoms following the subsequent experiments,--the pallor and depression, the blue lips, the difficulty in locomotion, the decided paresis and rigidity of muscles, the profound unconsciousness, THE FINAL PARALYSIS? Do omissions like these suggest an ardent desire to present the whole truth of the matter for the information of the public?

The defender of the experiments tells us:

"It is not an uncommon procedure in neurologic surgery, to stimulate after operation, in conscious patients, certain areas of the brain. This procedure is a familiar one to all neurologists, and it is THEREFORE DIFFICULT to understand why so much has been made of these early observations in Cincinnati."[1]

[1] Italics not in original.

Aside from the astounding confession contained in this admission of familiar procedure, it is difficult to understand what is meant by this paragraph. Is it a suggestion that these experiments upon Mary Rafferty were observations following a remedial surgical operation? It is surely impossible that this can be the meaning; for in the original account of the "Investigations into the function of the human brain," there is not a line in support of such hypothesis. The reader may make his own interpretation of a paragraph which seems exceedingly obscure.

No apology for these experiments could be complete, which did not refer to the alleged "consent." It is thus presented:

"If the patient under these circumstances consented to the observations described, it would appear to be a matter between herself and the physician making the observations."

This is the view of the matter which the apologist invites us to accept. On the one side, stands a poor, ignorant, feeble-minded Irish servant girl, full of faith and implicit trust in the benevolence of those about her; on the other a learned scientist, eager, as he says, "to ascertain how far the results of experiments on the brains of animals may be employed to elucidate the functions of the human brain"; and her "consent" to procedures the purpose and dangers of which she knows nothing,--to experiments involving her life, are suggested as a justification of whatever was done, and as a matter with which Society need have no concern!

Upon such methods of vindication every intelligent reader may form his own judgment. He will doubtless reach the conclusion that such vital omission of essential facts,--no matter whether accidental or intentional,--absolutely nullifies the value of the entire apology. Let us hope that the next defender of these experiments, writing not only for the instruction of the medical profession but also for the general public, will proceed along somewhat different lines; that every symptom which Bartholow mentions, he will mention also; that if he speaks of the "CONSENT" of the victim, he will frankly tell us that it was consent of one whom the experimenter himself called rather "feeble-minded"; and that if he thinks other palliating circumstances exist, he will at least graciously furnish us with references to the evidence presented by the experimenter, upon which he grounds his belief.

II. Experiments with Poison.

Of all experiments upon patients in hospitals, probably one of the boldest was Dr. Sydney Ringer, physician to the University College Hospital in London. His position in this institution gave him a peculiarly favourable opportunity for the utilization of the human "material" under his care. The experiments upon his patients were frankly reported by himself, and were published in his well-known work on Therapeutics.[1] For the most part these experiments were made with poisonous drugs. Are we justified in classing them as human vivisections? If in any case, the drug can be shown to have been administered for the welfare of the patient, it was legitimate medical treatment, to which criticism does not apply. Were the drugs so administered? The experimenter shall describe his work in his own language.

[1] "Handbook of Therapeutics," by Sydney Ringer, M.D. Eighth edition, William Wood and Co., New York.

Poisoning with Salicine

"In conjunction with Mr. Bury, I have made some investigations concerning the action of salicine on the human body, USING HEALTHY CHILDREN FOR OUR EXPERIMENTS, to whom we gave doses sufficient to produce toxic (poisonous) symptoms. We tested the effects of salicine in three sets of experiments ON THREE HEALTHY LADS. To the first two, we gave large doses, and produced decided symptoms.... Under toxic (poisonous) but not dangerous doses, the headache is often very severe, so that the patient buries his head in the pillow. There may be very marked muscular weakness and tremour...."

Another "set of experiments" was made on a boy ten years old, who had been brought to the hospital to be treated for belladonna poisoning. "Our observations," said Dr. Rigner, "were not commnced TILL SOME DAYS AFER HIS COMPLETE RECOVERY." Among effects of the experiment was a severe headache,--"so severe that the lad shut his eyes and buried his head in his arm...became dull and stupid, lying with his eyes closed...."

Other experiments were made upon a boy only nine years old, almost well from an attack of pneumonia, the temperature having become normal over a week before. Dr. Ringer's experiment went so far as to give him apparently considerable apprehension. He speaks of the flushed face, the trembling hand, and lips, the laboured breathing, the spasmodic movements of limbs.

"These symptoms were at their height at midday, and were so marked, and the pulse and respirations so quick, that we must confess we felt a little relief when the toxic (poisonous) symptoms which became FAR MORE MARKED THAN WE EXPECTED, abated; not that at any time the boy was dangerously ill; but as the symptoms progressed, after discontinuing the medicine, WE DID NOT KNOW HOW LONG AND TO WHAT DEGREE THEY MIGHT INCREASE." (!)

What shall be said of experiments like these, made upon children who had almost or quite recovered from ailments for which medical advice was sought?

Poisoning with Ethyl-Atropium.

This drug has no recognized medical use. In order to make experiments with it upon patients under his care, Dr. Ringer was obliged to have it specially manufactured. He refers to "our experiments upon man," and states that the poisonous substance

"produces decided but transient paralysis, THE PATIENT BEING UNABLE TO STAND OR WALK, and the head dropping rather toward the shoulder or chest, and the upper eyelids drooping."[1]

[1] Ringer's "Therapeutics," p. 534.

Experiments with Tartar-Emetic, or Antimony.

Of this poison, an American authority tells us that "the fraction of a grain" may be followed by a fatal result. Dr. Ringer states, nevertheless, that,

"TO A STRONG YOUNG MAN, I gave tartar-emetic in the 1/2-grain doses every ten minutes for nearly seven hours, INDUCING GREAT NAUSEA AND VOMITING with profuse perspiration."[2]

[2] Ibid., p. 273

Twenty-one grains of antimony administered to "a strong young man," though a fatal result may be inducted by a fraction of a single grain!

Poisoning with Alcohol.

With this substance, Dr. Ringer tells us he made a great many observations "every quarter of an hour for several hours ON PERSONS OF ALL AGES.... After poisonous doses, the depression (of temperature) in one instance reached nearly three degrees."

Does this sinister confession mean that even infants were the objects of his scientific zeal? It is certain that some children were subjected to this experiment, for he says:

"In a boy aged ten, who had never in his life before taken alcohol in any form, I found through A LARGE NUMBER OF OBSERVATIONS, a constant and decided reduction of temperature."

Is there any parent who would be willing to have his ten-year-old boy subjected to an experiment like this?

Poisoning with Nitrate of Sodium.

"To eighteen adults, fourteen men and four women, we ordered 10 grains of pure nitrate of sodium in an ounce of water, and of these, seventeen declared they were unable to take it.... One man, a burly strong fellow, suffering from a little rheumatism only, said that after taking the first dose, he felt giddy as if he `would go off insensible.' His lips, face, and hands turned blue, and he had to lie down an hour and a half before he dared moved. His heart fluttered, and he suffered from throbbing pains in the head. He was urged to try another dose, but declined on the ground THAT HE HAD A WIFE AND FAMILY...."[1]

[1] The London Lancet, November 3, 1883, p. 767

When this account of hospital experimentation first appeared in the Lancet, another medical journal made the following comment:

"In publishing, and indeed, in instituting these reckless experiments on the effect of nitrate of sodium on the human subject, Professor Ringer and Dr. Murrill have made a deplorably false move, which the ever watchful opponenets of vivisection will not be slow to profit by.... It is impossible to read the paper in last week's Lancet without distress. Of eighteen adults to whom Drs. Ringer and Murrill administered the drug in 10-grain doses--all but one avowed they would expect to drop down dead if they ever took another dose. One woman fell to the ground, and lay with throbbing head and nausea for three hours; another said it turned her lips quite black, and upset her so that she was afraid that she would never get over it.... One girl vomited for two hours and thought she was dying. All these observations are recorded with an innocent naivete as though the idea that anyone could possibly take exception to them were far from the writers' minds. But whatever credit may be given to Drs. Ringer and Murrill for scientific enthusiasm, it is impossible to acquit them of grave indiscretion. THERE WILL BE A HOWL THROUGHOUT THE COUNTRY IF IT COMES OUT that officers of a public charity are in the habit of trying SUCH USELESS AND CRUEL EXPERIMENTS on the patients committed to their care...."[1]

[1] Medical Times and Gazette, November 10, 1883.

"CRUEL AND USELESS EXPERIMENTS ON PATIENTS"--that was the judgment of a medical journal of the day. Any stronger condemnation now is hardly necessary.

What is the judgment of the reader upon investigations of this character? Here we have a physician making use of the bodies of his patients for the testing of poisonous drugs, apparently without the slightest regard for the poor and ignorant fellow-beings who had confidently placed themselves under his care. Can such experimentation as this be termed anything but human vivisection? Once we admit that patients in hospitals have no rights superior to scientific demands, and there is hardly a limit to which such experimentation may not be carried on the poor, the ignorant, the feeble-minded and the defenceless.

III. Experiments involving the Eye

Recent experiments with tuberculin, made upon the eyes of children and other patients in public institutions, seem in many cases to have been carried to an extent not easily justified by ordinary ethical ideals. It is impossible to quote all the cases of this phase of human experimentation; but enough can be given to afford any reader the opportunity of judging the morality of the practice.

The experiments in question had one or more of the following characteristics, distinguishing them from ordinary medical treatment:

1. They were made indiscriminately upon large numbers of children or adults, who were under treatment for various ailments. 2. They appear to have been purely experimental in character, and without purpose of individual benefit. 3. They seem to have involved in some cases considerable discomfort or pain and the risk of irreparable injury to the sight. 4. Dying children apparently were not exempt from experimentation.

A recent medical writer, defding the experiments, points out that the tuberculin test could not convey the infection. The test, he says,

"depends on the principle that if a fluid in which tubercle bacilli have grown, and which therefore contains the chemical products of their growth is injected into an animal or person suffering from tuberculosis, a transient increase of temperature occurs, and constitutes the chief sign of a positive reaction.... Later it was found that if the diluted tuberculin was placed on the surface of the eye, there followed in tuberculous persons, a reddening or congestion of the eye, which might go on to the stage of mild conjunctivitis."[1]

[1] Journal of the American Medical Association, February 28, 1914.

Is this a fair summary of the dangers of the eye-test? Let us see what the experimenters tell us.

In the Archives of Internal Medicine for December 15, 1908, two experimenters describe their work. When a drop of turberculin solution is instilled into the eye of certain cases, there occurs, they say, an infetion which varies in intensity in different individuals, "usually attended by lachrimation and moderate fibrinous or fibro-purulent exudation WHICH MAY GO ON TO PROFUSE SUPPURATION." This "profuse suppuration" is something rather more severe than the symptoms described by the apologist just quoted.

The experimenters say:

"Practically, all our patients were under eight years of age, and all but twenty-sex of them were inmates of St. Vincent's Home, an institution with a population of about four hundred, COMPOSED OF FOUNDLINGS, ORPHANS, AND DESTITUTE CHILDREN. The cases in the Home were tested in routine by wards, IRRESPECTIVE OF THE CONDITIONS FROM WHICH THEY WERE SUFFERING, and in the great majority of instances without any knowledge of their physical condition prior to, or at the time that the tests were applied. We purposely deferred the physical examination of these children until after the tests had been applied."

Would any medical practitioner, called to the house of a wealthy man to examine his ailing child, purposely defer its physical examination until after this eye-test had been applied?

Many of the children were suffering from various ailments at the time this test was made. Some had rickets, some typhoid fever, some whooping-cough, pleurisy, pneumonia or heart disease. Some of them were already near their end; in one case we are told that the "tests were applied within eight days of death"; upon another emaciated infant, the test was "applied three days before death." Infancy earned no immunity from experimentation, for the eye-test was said to have been applied "to seventeen infants, ranging in age from four weeks to five months." In this group of cases, one infant was tested within the last twenty-four hours of its pitiful and painful existence.

What were the possible consequences of these tests upon the sight of the orphans and foundlings of St. Vincent's Home? The experimenters frankly confess that at the outset they did not know.

"Before beginning application of the conjunctival test, WE HAD NO KNOWLEDGE OF ANY SERIOUS RESULTS FROM ITS USE.... It has the great disadvantage of producing a decidedly uncomfortable lesion, and it is not infrequently followed by serious inflammations of the eye, which not only produce great physical discomfort and require weeks of active tratment, BUT WHICH MAY PERMANENTLY AFFECT THE VISION, AND EVEN LEAD TO ITS COMPLETE DESTRUCTION.... W ehave had a number of verbal reports of eye complications, some of them relating to very serious conditions; and we are sure they are much commoner than the references we have communicated would indicate.... In fact we are strongly of the opinion that any diagnostic procedure which will so frequently result in serious lesions of the eye has no justification in medicine...."

The conclusions concernng the occasionally disastrous consequences of this eye-test were shortly confirmed by other experimenters. During the following year, two Massachusetts physicians reported a study made in "the out-patient clinic of the Carney Hospital and the Massachusetts Chartiable Eye and Ear Infirmary," and they add: "We are most indebted to the staff of the latter institution for allowing us to make use of their material.... We have discarded the conjunctival test, AS BEING OCCASIONALLY PRODUCTIVE OF DISASTROUS RESULTS."

In May, 1909, two Baltimore physicians reported their trials with two forms of the tuberculin tests, "the result of over a year of experience with patients coming to the Phipps Dispensary of the Johns Hopkins Hospital." A year later they make an additional report.

"In May, 1909, we reported the results of the conjunctival and cutaneous test in 500 patients. The present report deals with 1,000 additional patients to whom these tests were administered, and who formed THE UNSELECTED MATERIAL OF AN AMBULANT CLINIC, the Phipps Dispensary of the Johns Hopkins Hospital."

They, too, suggest the necessity for caution in making this experiment. If a drop of the tuberculin, first in one eye and then in the other, produced no reaction,

"we refrained from further instillations, fearing the possible intensity of a reaction consequent upon a second instillation of tuberculin into an eye. Our fear is based on evidence, gathered accidentally, that a second instillation may give a positive and even a severe reaction in a case in which a similar test gave a negative result.

In January, 1909, one of the professors connected with the College of Physicians and Surgeons, New York, published a "Report upon one thousand Tuberculin tests in young children." He says:

"The observations included in the following report were all made at the Babies' Hospital upon ward patients. Very few of the children were over three years of age, the majority being under two years.... In the early part of the year, unless some positive contra-indication existed, some test, more frequently the eye-test, was used as a routine measure in order to determine whether and under what circumstances reactions were obtained in HEALTHY CHILDREN, or in those at least PRESUMABLY NON-TUBERCULAR."[1]

[1] Archives of Pediatrics, January, 1909.

This is perfectly plain. Healthy children, or children presumably without any symptoms of tuberculosis, were experimented upon in order to see whether a positive reaction could be obtained. Of 555 cases of infants subjected to this test, who were presumably not tubercular, only two gave a positive reaction, although there were seven cases in which the reaction was doubtful.

We are told by this writer that "care was taken not to use tuberculin in an eye which was the seat of any form of disease, tuberculous or otherwise," and to this precaution, he ascribes his freedom "from unpleasant results." He insists that "on account of the kind of observation necessary, and the possible dangers connected with the eye-test, it is not wise to employ it indiscriminately, as among the out-patients of a hospital." Undoubtedly this is true; and he repeats the advice: the ophthalmic test "CANNOT WELL BE USED IN AMBULATORY PATIENTS." Yet we have just seen that the test WAS thus used in the large number of cases "who formed the unselected material of an ambulant clinic" from another well-known hospital dispensary.

The final judgment of the experimenter does not appear to be entirely favourable to the test involving the eye, though he insists that with proper precautions it is safe. Taken apart from the physical signs and general symptoms, the tests may mislead. "Some failures and some unexplained reactions occurred with all the tests." Even though safe, yet

"an intense or prolonged reaction sometimes occurs which is not pleasant to see; besides, in pathological conditions of the eye, DISASTROUS RESULTS MAY FOLLOW. THE EYE IS TOO DELICATE AND IMPORTANT AN ORGAN TO BE USED AS A TEST WHEN ANY OTHER WILL ANSWER QUITE AS WELL."

With this sensible conclusion it is quite impossible to disagree.

Another question is of importance. For these experiments upon the eye, WERE DYING CHILDREN EVER USED AS MATERIAL?

Apparently, there can be no doubt of the fact. The experimenter distinctly states that "DYING CHILDREN, or those who were extremely sick did not as a rule, react to any of the tests." The assertion is repeated: "In no case were positive reactions obtained in DYING CHILDREN."

In one of the tables, there is also a reference to dying children.

We are told that "the hands of the children were confined during the first twelve hours, to prevent any rubbing of the eye."

Can it be that dying children were thus treated? We are not told to the contrary. Yet it would seem that impending death might well have conferred immunity, not merely from such restraint but from the entire experiment. The thought of a dying child with fettered hands, is not a picture upon which the imagination would willingly dwell.

Upon these experiments involving the eye, what judgment is a plain man entitled to make?

In the first place, he should draw a clear distinction between the experiments made upon tuberculous patients, and those made upon healthy children. Among the large number of experiments, it is possible that some were made upon carefully selected cases for the personal benefit of the individuals concerned. Regarding these, opinions may differ as to expediency; but they belong to the rightful province of medical tratment,--wise or otherwise. But if these tests were applied without discrimination, without previous inquiry into their condition; if they were made only upon the eyes of the orphans and foundlings, and the poor in hospital and dispensary, and not upon the children of the wealthier classes; if in large numbers, men, women and children were made "the unselected material" for tests wherein their individual welfare was not sought, in experiments which not only "produced great physical discomfort" but were liable also to "permanently affect the vision, and even lead to its entire destruction," it would seem impossible to regard them with admiration or approval. Would any of us care to have his own dying child, separated from its mother, and with hands confined, made the "material" for any such experiment? Should we care to have anyone dear to us, subjected to the risks which seem to have been so freely imposed upon the unfortunate, the ignorant, the poor? That is the test by which ultimately these experiments will be judged.

IV. The Rockefeller Institute, and Experimentation on Human Beings

In public esteem, the Rockefeller Institute undoubtedly occupies an exceptionally hight position. It would seem to be generally believed, that by reason of experiments made within its walls upon the lower animals, discoveries of the utmost value to the human race are bing added to the resources of medical science. Possibly, a careful analysis of its work might disprove this belief, but that is aside from present inquiry. A more important question confronts us,--the extent to which under the authority of this Institution, human beings as well as animals have been used as "material" from researches altogether unconnected with their personal benefit. If such experiments have in truth been made under the authority of the Rockefeller Institute, it would seem to be of the utmost importance that the exact truth be made known. It is not always easy to state medical facts in popular language, but the attempt shall be made. --------------- When Columbus returned from his discovery of a new world, it is now generally believed that he brought to Europe the germ of one of the most terrible diseases which have ever afflicted the human race. The extent of its malignancy has only been known within the past century. The unborn infant may be touched by it with the possibility of great suffering, and the probability of an early death. There is not an organ of the human body which may not become the seat of its ravages. The majority of other infectious diseases leave their victim after a time; this makes its home within the body and may manifest its malignity after almost a lifetime of quiescence. In its contribution to the sum total of suffering which disease has occasioned the human race, it is probably that with one exception, syphilis stnds above every other human ailment.

On March 3, 1905, a young German biologist by the name of Schaudinn discovered under the microscope what is now generally believed to be the germ of this terrible disease. It is a minute, spiral-shaped organism, with six or eight curves, and capable of movement in space. Its place in the scheme of existence is not wholly certain, but the probability seems that it is a protozoan, belonging to the lowest form of animal life. Its very simplicity makes it appalling; we do not understand how anything so innocent in appearance, can occasion such terrible ravages. In the course of the evolution of life how came it into being? We can only surmise. But once having gained a foothold in the body of a human being, the minute organism begins to multiply: and penetrating to any part of the body, it induces the ravages of a destroyer espite all the opposing defences which Nature may raise against it. The discoverer first called it the "Spirochaete pallidum," but later invented a new name--"Treponema pallidum"--by which it is at present generally known. It is almost ceratin that in this minute organism, invisible to the naked eye, we have the causative agent of one of the great destroyers of the human race.

A Japanese physician, connected with various phases of research work in the Rockefeller Institute (Dr. Hideyo Noguchi), believed it would be possible to device a method for detecting the existence of these germs of syphilis in certain latent and obscure cases, where the disease was merely suspected. He had no though of inventing a cure for the disease; it was a method of detection only. By ingenious procedures which it is unnecessary here to describe, Dr. Noguchi succeeded in cultivating these germs OUTSIDE THE HUMAN BODY; and after grinding them in a sterile mortar, and subjecting them to heat with other manipulations, he found himself finally in possession of an extract or emulsion to which he gave the name of "luetin." It contains the germs of syphilis; but they are intended to be DEAD GERMS. The experimenter himself says:

"I have proposed the name LUETIN for an emulsion or extract of pure culture of Treponema pallidum, which is designed to be employed for obtaining in suitable cases, a specific cutaneous reaction that may become a valuable diagnostic sign in certain stages or forms of syphilitic infection."

Now, if a drop of this luetin be introduced beneath the skin of a child who has inherited the disease, or of a person who has suffered from its obscurer symptoms, there may be produced a "reaction." This may take the form of "a large, indurated, reddish papule" which in a pew days become of a dark, bluish-red colour; or the inflammation may be of a severer type, resulting in a "pustule." A positive result is more frequently obtained when the disease is of long standing, or comparatively inactive. But may not this "reaction" occur in every case, whether or not the individual has ever been affected by the diseas? Anyone can see that if this "reaction" manifests itself in ALL cases, the luetin test has no value whatever. And it was in the prosecution of this phase of research that certain experiments upon human beings were made, which have been criticized. Dr. Noguchi and other physicians injected this luetin emulsion containing the dead germs of syphilis, not only into persons presumed once to have been affected by the loathsome disease, but also into the bodies of 146 other persons, INCLUDING CHILDREN, ENTIRELY FREE FROM THE DISEASE. It would seem that he was advised by an American physician to make his experiments on human beings rather than upon animals. He tells us:

"...In 1910-11, I commenced my experimental work on rabbits.... While I was still working with the animals, PROFESSOR WELCH SUGGESTED THAT I MADE THE TEST ON HUMAN SUBJECTS. Through his encouragement, I commenced the work at once at different dispensaries and hospitals, with the co-operation of the physicians in charge."

Whatever criticism may attach to these experiments, it ought not to fall upon the Japanese investigator, encouraged and supported as he was, by both Christian and Jewish physicians. In appreciation of the assistance afforded him at various charitable institutions, Dr. Noguchi says:

"Through the courtesy and collaboration of--

Dr. Martin Cohen .. Harlem Hospital, Randall's Island Asylum, and New York Ophthalmic and Aural Institute; Dr. Henderson .. State Hospital, Ward's Island, N.Y.; Dr. Lapowski .. Good Samaritan Dispensary; Dr. McDonald .. King's County Hospital; Dr. Orleman-Robinson North-Western Clinic, New York Polyclinic; Dr. Pollitzer .. German Hospital; Dr. Rosenoff .. King's Park State Hospital; Dr. Satenstein .. City Hospital, Blackwell's Island, N.Y.; Dr. Schmitter .. Capt., U.S. Army, Fort Slocum; Dr. Schradieck .. King's County Hospital; Dr. Charles Schwartz California; Dr. Smith .. .. Long Island State Hospital; Dr. Strong .. .. Manhattan Eye, Ear and Throat Hospital; Dr. Swinburn .. Good Samaritan Dispensary; Dr. Windfield .. King's County Hospital; Dr. Wiseman .. King's Park State Hospital;

And the Hospital of the Rockefeller Institute for Medical Research, I was enabled to apply the skin reaction to a number of human cases... The total number of cases was 400."[1]

[1] Journal of Experimental Medicine, vol.xvi. In the original, the names of the hospitals are somewhat obscured by being placed in brackets, and the paragraph made continuous; they are here printed in capitals, to afford the reader a better opportunity of giving these charitable institutions whatever credit is due them.

Four hundred patients in hospitals and dispensaries including the hospital attached to the Rockefeller Institute for Medical Research, were used as "material" for determining the value of a test for latent syphilis. Of these, 146 were healthy individuals, used as "controls."

Dr. Noguchi states that these "controls"

"include 146 normal individuals, chiefly children between the ages of two and eighteen years; and 100 individuals suffering from various diseasess of a non-syphilitic nature.... In none was a positive luetin reaction obtained."

Other experimenters upon human beings have made reports of their investigations in the same direction. A physician of St. Louis in a medical journal, tells us of forty-four cases in which the Noguchi luetin was applied, and he expresses his obligation to eight physicians of that city (naming them), "for the privilege of using THEIR CASES FOR THE WORK."[1] Whether these "CASES" were the private patients of the accomodating physicians, we are not informed. This experimenter had not completed his investigations and announced his intention of "trying it out thoroughly" in a certain St. Louis hospital, which he names.

[1] New York Medical Record, May 25, 1912.

The same experiments appear to have been made in other institutions. In the Bulletin of the Johns Hopkins Hospital for August, 1912, there appears an account of this luetin test, made upon patients suffering from such ailments as rheumatic fever, typhoid fever and consumption. We see that the practice has extended to some of the leading hospitals of the United States.

The defence of all hospital experimentation upon children and adults, other than procedures for their own benefit, is usually grounded upon (1) the absence of any severe injury, and (2) the value of the results obtained. The defenders of the Noguchi experiments insist that the disease was not transmitted; that there was no severe pain or permanent injury; and that the inoclation with dead germs of syphilis could not have caused an infection with the dread disease. This is probably true; although the excuse of painlessness cannot be fairly put forward regarding the tuberculin experiments upon the eye. But should we overlook the fact that these tests, at first were purely experimental in character? No absolute assurance of results could have been declared in advance; if certainty existed beforehand, what would be the use of experimenting upon so many human beings? Are experiments upon man only reprehensible when injury follows? Do we apply this rule to the engineer of a passenger-train, who again and again runs by a danger-signal, and yet escapes a tragedy?

The utility of experimentation is urged. Only by experiments upon human beings, it is said, could the value of either the tuberculin test or the Noguchi emulsion be definitely determined. But surely every thinking man must realize that utility cannot exculpate, or justify the use of any method which is otherwise wrong in itself. A murder is not regarded as pardonable, because thereby the interests of religion are advanced. Dr. Noguchi for instance, admits that although it is almost certain that the germs which Schaudinn discovered and which he has isolated and grown outside the human body, are the cause of specific disease, yet scientific certainty can only be acquired by producing the ailment from the artificially cultivated germs. He says:

"While there are few, to-day, who would deny that the Treponema pallidum is the causitive agent of syphilis, YET THE FINAL PROOF CAN ONLY BE BROUGHT FORTH THROUGH THE REPRODUCTION OF SYPHILITIC LESIONS BY MEANS OF PURE CULTURES OF THE MICRO-ORGANISM."[1]

[1] "Studies of the Rockefeller Institute," vol. xiv., p. 100.

A scientific experiment upon a human being of greater interest than this it is hardly possible to imagine. With germs invisible to the naked eye, grown in a flask, will some future experimenter be able to produce in a human being all the terrible symptoms of this worst scourge of the human race? That the experiment will be tried, there can be no doubt; experiments involving the inoculation of the same horrible disease, have been made both in America and in Europe. But does anyone think that the utility of this suggested experiment of Dr. Noguchi would justify its being made upon an unsuspicious patient in a charity hospital? Would it be likely to meet general approbation, even in our day, if it were performed upon an infant in a Babies' Hospital? And yet why should it be criticized, if utility to science is a sufficient excuse?

It is a significant fact, that every writer who attempts to defend or to excuse the experiments here described and others of the same type, always evades the principal reason for their condemnation. The condemnation of what may be called "human vivisection" rests chiefly upon its incurable injustice.

ALL SUCH EXPERIMENTS VIOLATE ONE OF THE MOST SACRED OF HUMAN RIGHTS. Every man, not a criminal, has the inherent right to the inviolability of his own body, except for his own personal benefit. Apply this to the experiments herein described.

THEY IMPLY A SUPPRESION OF THE TRUTH. Is it probably that any mother, bringing to a hospital her ailing child, would leave it there without apprehension if she were distinctly informed that when it had partly recovered, it would be used for experimentation relating to a test for syphilis?

THEY IMPLY A PHASE OF DECEPTION, so far as a formal "consent" is ever obtained without a full and complete statemnet of possible dangers. Can we imagine Mary Rafferty to have consented to Bartholow's experiments upon her brain, if, in full possession of her intellectual faculties, she had known--as he knew,--what risks they involved? It is the performance of experiments upon dying children, upon infants for no urpose of individual benefit, upon men and women all unconscious of the character of the investigation; the imposition upon the ignorant and confiding of unknown risks; the utilization for experimentation under cover of treatment for their ailments, of the poor, the feeble- minded, the unfortunate, without their full, intelligent and adequate consent, that makes the practice abhorrent to every conception of morality, and every ideal of honour.

How such experiments are coming to be regarded, we may see in a recent article from the pen of Dr. Francis H. Rowley, president of the Massachusetts Society for the Prevention of Cruelty to Animals:

"The use of children in hospitals, or anywhere else, as material for experimentation is not to be tolerated for a moment, in our judgment, by any right-minded man or woman. Whatever is conscientiously done for the benefit of the child itself, to save it from disease or to lessen its suffering, though it may cause it temporarily more or less pain, is nothing against which objection should be made. But to use the child, even when no permanent harm may result to it, as a subject upon which to try out certain theories, or to test the efficacy of certain drugs, so long as this is not absolutely for the good of the individual child treated rather than for children in general, is abhorrent to the most of us. To cause a helpless baby one hour's distress, to say nothing of suffering, for the sake even of other children, when that baby has been brought to the hospital by its parents or guardians solely for what may be done for its benefit, we hold to be a breach of trust on the part of hospital authorities and physicians that hasn't the slightest defence either in morals or in law.

"We write these words not because we believe that any physician is so far fallen below the lowest levels of our common humanity as to inject into a defenceless child the active germs of a loathsome or possibly fatal disease, but because our moral sense is outraged at any treatment of the child such as we should refuse to permit were the child our own. We believe he universal assertial of parents would be that, if having taken their child to a hospital for tratment, they learned that it had beenused for experimentation, though no lasting harm could come to it from the experiment, someone would pay the penalty for the unwarranted deed, if money or influence or, these failing, muscle, could reach far enough to find the offender."

Does such condemnation of experimentation upon the hospital patient or children tend to block scientific advance? Not at all. A recent writer tells us that "once it is evident that man himself must be the experimental animal, the scientist volunteer is always ready." If this be so, why should not the human "material" be acquired always in a way to which the charge of unjust procedure would never be applicable? If assurance could have been given that the luetin test implied no risk of any kind, might not the Rockefeller Institute have secured any number of volunteers by the offer of a gratuity of twenty or thirty dollars as a compensation for any discomfort that might be endured? Of the thousands of medical students in the State of New York, are there not hundreds who would have offered with eagerness to submit to a test devoid of peril, in the interests of scientific research? And even if an experiment implied danger, might there not be sufficient compensation for all risks? Every year firemen lose their lives in the flames, and policemen are murdered. The compensation they receive induces them to incur risks that might not otherwise be assumed. A great theologian is said to have affirmed that a man, perishing from starvation, had the moral right to take a loaf of bread that did not belong to him, if only thus he could preserve his life. Is Science ever in such straits of necessity that in a single instance it is obliged to take from any man his supreme right of inviolability, and to make its experiments within the wards of the hospital, upon the eyes of the dying, upon the bodies of the ignorant and the poor?

There is yet another method by which perhaps we may test the morality of the practice. A great philosopher of another century seeking to find some criterion of man's duty toward his fellow-men, based obligation upon a universal law. "Act," said Kant, "as if the motive of thy conduct were to become by thy will a universal law." Suppose we apply this maxim of Kant to the use of human beings for research purposes. An experimenter in a hospital makes dying children his material. Is he willing that the maxim of his act should be universal, and apply to experiments upon his own child, when it lies at the point of death? He plunges needle-electrodes into the brain of a simple-minded and perhaps friendless servant-girl. Can we imagine him willing that the motive of his deed should govern and justify experiments of the same kind made upon his mother or his wife? Following Ringer, he tests the actions of poisons upon patients in some hospital under his control. Would he be willing that the law be universal, and that the action of such drugs should first be tested upon himself? He suggests the use of healthy children as "controls" in tests with the dead germs of a horrible disease. Is there anyone connected with the Rockefeller Institute, for example, who would be willing that such act should establish a universal precedent, and that his own children should be taken, and without his knowledge, made the "material" for such research?

Admitting that some experiments upon human being may be ethically permissible, and that other phases of such investigations are morally wrong, how are we to distinguish between them? May it not be possible to indicate principles which would be generally accepted, according to which the line may be drawn? Let us make the attempt.

I. Justifiable Experimentation upon Man

1. All experiments made by intelligent and conscientious physicians or surgeons upon their patients for some definite purpose pertaining to the personal benefit of the patient himself, and when practicable, in case of risk, with his or her consent. (This rule is intended to include every possible experiment made by a medical practitioner for the benefit of the patient, with a distinct ameliorative purpose in view.)

2. All experiments made with an intelligent purpose by a scientific man or medical practitioner upon himself.

3. All experiments made with their consent upon physicians, surgeons, pathologists, medical students or other scientific men, who, aware of the nature of the investigation and of possible results, voluntarily offer themselves as "material."

4. All experiments made upon men or women of ordinary intelligence who, having been fully informed of the nature of the investigation and of whatever distressing or dangerous consequences are obviously liable to result, acknowledge the receipt of satisfactory compensation for all risks, and give in writing their full and free consent.

5. All psychological experiments or tests which involve neither fear, fright, nor mental distress of any kind.

II. Unjustifiable Experimentation upon Human Beings.

Experiments upon human beings which would seem to be immoral, because obviously a violation of human rights, are as follows:

1. ALL EXPERIMENTS, TESTS OR OBSERVATIONS, LIABLE TO INVOLVE ANY DEGREE OF PAIN, DISCOMFORT, OR DISTRESS, MADE UPON DYING CHILDREN, OR CHILDREN APPARENTLY NEAR DEATH, FOR ANY PURPOSE OTHER THAN THEIR PRESENT PERSONAL RELIEF.

2. The use of new-born babes as material for research; the use as material for research of any other defenceless children, in orphanages, asylums, or in their own homes, for any purpose whatever other than the direct personal benefit of the child upon whom the experiment is made. Especially objectionable would seem to be experiments of this character made in connection with the study of syphilis, whether or not any obvious injury is the result.

3. All experiments liable to cause discomfort or distress, made without purpose of definite individual benefit upon the insane, the feeble-minded, the aged and infirm or upon other unfortunate human beings, who, for any reason, are incapable of giving an intelligent consent or of adequately comprehending what is done to them.

4. All experiments of any kin, upon other adults, whether patients or inmates of public institutions or otherwise, if made without direct ameliorative purpose and the intelligent personal consent of the person who is the MATERIAL for the research.

5. The experimental exploitation without their free consent, of men, temporarily under command or control of an authority which they have been led to suppose they are not at liberty legally to disobey.

Let us repeat. THERE IS NO OBJECTION TO EXPERIMENTS UPON HUMAN BEINGS, WHEN THERE IS NO INVASION OF HUMAN RIGHTS. The medical student, who, out of zeal for Science, offers his body for any experimental test; the patient in the hosptial, who with adeuqate compensation for what he is asked to undergo, grants consent to some investigation which may help others, though not himself; the poor man who is satisfactorily compensated for all risks, and therefore willing to aid research,--such varieties of human experimentation do not necessarily offend the moral sense. It is the incurable injustice of experimentation upon infancy that can offer no protest but a cry; of experimentation upon the dying child, of experimentation upon the poor, the ignorant, the feeble-minded, the defenceless,--it is experimentation like this which surely deserves the condemnation of mankind.

What is the remedy for human vivisection? It lies in such legislation as shall protect those who, because of infancy, or by reason of ignorance cannot effectively protect themselves. By penalties so heavy that they cannot be safely ignored, the State must forbid the iniquitous exploitation of man by man. No such law need interfere in the slightest degree with the rights of the true physician to aid his fellow-beings; nor can we doubt that the medical profession will finally favour a reform that will indicate the broad line of demarcation separating the unquestioned privilege from the unjustifiable abuse.