An Ethical Problem Part 23

[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 inst.i.tuting 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 inst.i.tutions, 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 const.i.tutes 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 a.s.sociation, 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-s.e.x of them were inmates of St. Vincent's Home, an inst.i.tution with a population of about four hundred, COMPOSED OF FOUNDLINGS, ORPHANS, AND DESt.i.tUTE 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 pract.i.tioner, 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 Ma.s.sachusetts physicians reported a study made in "the out-patient clinic of the Carney Hospital and the Ma.s.sachusetts Chartiable Eye and Ear Infirmary," and they add: "We are most indebted to the staff of the latter inst.i.tution 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 circ.u.mstances 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.