An Ethical Problem Part 24

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 a.s.sertion 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 ent.i.tled 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 cla.s.ses; 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 Inst.i.tute, and Experimentation on Human Beings

In public esteem, the Rockefeller Inst.i.tute 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 a.n.a.lysis 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 Inst.i.tution, 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 Inst.i.tute, 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 s.p.a.ce.

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 j.a.panese physician, connected with various phases of research work in the Rockefeller Inst.i.tute (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 j.a.panese investigator, encouraged and supported as he was, by both Christian and Jewish physicians. In appreciation of the a.s.sistance afforded him at various charitable inst.i.tutions, Dr. Noguchi says:

"Through the courtesy and collaboration of--

Dr. Martin Cohen .. Harlem Hospital, Randall's Island Asylum, and New York Ophthalmic and Aural Inst.i.tute; 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 Sloc.u.m; 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 Inst.i.tute 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 inst.i.tutions whatever credit is due them.

Four hundred patients in hospitals and dispensaries including the hospital attached to the Rockefeller Inst.i.tute 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 inst.i.tutions.

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 a.s.surance 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 pa.s.senger-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 Inst.i.tute," 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 princ.i.p.al 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 Ma.s.sachusetts 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 a.s.sertial 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 a.s.surance could have been given that the luetin test implied no risk of any kind, might not the Rockefeller Inst.i.tute 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 a.s.sumed. 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 Inst.i.tute, 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 pract.i.tioner 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 pract.i.tioner 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."