An Ethical Problem Part 29

APPENDIX VI

THE REGULATION OF EXPERIMENTATION ON HUMAN BEINGS

A Bill for the regulation of the practice of experimentation upon human beings in the District of Columbia and elsewhere has been drawn, and will shortly be introduced in the Senate of the United States. An outline of the proposed Bill is here given, but in some respects it may be enlarged or modified before its final introduction. It is believed that a law may be framed which shall prohibit only those acts which are contrary to justice, and which should be forbidden by common consent.

--------------------------- A Bill for the Regulation of Scientific Experimentation upon Human Beings in the District of Columbia and in the Territories and Dependencies of the United States.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress a.s.sembled:

SECTION 1. That hereafter no person shall make upon any human being any scientific, medical or surgical experiment or operation, EXCEPT FOR THE BENEFIT OF THE PERSON EXPERIMENTED UPON, unless the intelligent, personal consent of such latter person shall previously have been obtained. Every such consent, to be valid, must be in writing and must be preceded by a full and correct written statement setting forth to the person whose consent is sought whatever painful, injurious or dangerous consequences are obviously liable to result from the proposed experimentation, and such statement shall be signed both by the experimenter and the person to be experimented upon.

SECTION 2. That experiments or operation of this nature shall be undertaken only by one of the responsible head-physicians or surgeons of some hospital or public instiution or by his special written authorization; provided only that nothing herein contained shall apply to scientific investigations incapable of causing injury, made by direction of authorities in charge of any inst.i.tution of learning, upon students, with their consent, for the purpose of testing acuteness of mental action, or for the purpose of investigating other mental or physical phenomena.

SECTION 3. That no scientific, medical or surgical experiment of any kind, liable to cause pain or distress or injury to health or danger to life, shall be permissible under any circ.u.mstances upon any new-born babe, or upon any infirm or aged or feeble-minded person, or upon anyone whose mental faculties are impaired, either temporarily or permanently, or upon any woman during pregnancy or within a year after her confinement, or upon any child under fifteen years of age, unless it be undertaken for the sole benefit of the person to be experimented upon; and the consent of any such person to any such experiment or operation shall not const.i.tute such legal consent as is required by this act, but shall be null and void.

SECTION 4. That the responsible head of any hospital or public inst.i.tution, in which any experiment or operation of any kinds mentioned in Section 1 of this Act shall have been made, shall on or before the first day of February in each year make a written report, attested by oath, to the Commissioners of the District of Columbia of all such experiments and operations that shall have been made in such hospital or public inst.i.tution during the calendar year next preceding, which report shall contain copies of the statements and of the consents required by said Section 1, together with detailed accounts of such experiments and operations and the results thereof; and such reports shall be printed annually.

SECTION 5. That any person who authorizes, performs or a.s.sists in performing an experiment or operation in violation of any provision of this Act shall be liable, upon conviction, to a fine not exceeding one thousand dollars ($1,000) and shall thereafter be incapable of legally engaging in the practice of medicine in the District of Columbia or in any territory under the jurisdiction of the United States, and of holding any official position of any kind under the Government of the United States

SECTION 6. That all sections of this Act shall be applicable to the District of Columbia and to all other territory under the jurisdiction or military control of the United States.

APPENDIX VII

SCIENTIFIC OPINIONS

A few years ago, Sir Benjamin Ward Richardson, M.D., a Fellow of the Royal Society and a distinguished sanitarian, was asked to express his opinion regarding experiments upon animals. He was a member of the medical profession; for some years he had been a lecturer on physiology in a medical school; he had been a practical experimenter, and his discoveries of new agents and methods for the prouction of anaesthesia had given him a high place in the scientific world. His reply to a series of questions was embodied in a volume ent.i.tled: "Biological Experimentation; its Function and Limits." Certain extracts from this work,--in some cases slightly abbreviated,--are here given. They are of special value, as the views of an eminent physician, a scientific discoverer, and a practical physiologist.

--------------------- If in creation there was no pain, if no pain could be extorted except by a physiologist, a physiologist inflicting pain, even for the cure of disease would be an accepted criminal by the general voice of mankind. But Nature is a laboratory of pain on the most gigantic scale; she stands at nothing in the way of infliction, spares nothing that is sentient. She inflicts pain for her own purposes, and she keeps it going.... If man inflicted such painful diseases as Nature inflicts, he would be a monster. Man rebels against these inflictions. Shall he add to pain by his rebellion?

--------------------- In Science, there is no one method that can be considered indispensable. Attributes are indispensable; observation, industry, accuracy are indispensable; methods are not. Methods may be convenient, they may be useful, they may be expedient, but nothing more. Celsus tells us that Erasistratus and the school he founded laid open the bodies of criminals in order to study by direct observation, the action of the intestinal organs during existence.

The act at that date of civilization probably shocked no one; it was no doubt in accord with the spirit of the time. In a day not very remote from our own, a criminal sentenced to death for some trivial crime, was given over to William Cheselden, surgeon to George the First, for experiment. The criminal was deaf and the experiment intended was that of making a puncture through the drum of the ear, in order to discover if an opening through the drum would enable the deaf to hear. At the last moment, Cheselden, a man of fine feeling, and brilliant as an operating surgeon, declined the experiment, on which the criminal, whose life had been conditionally spared, was set free.

For his generosity of mind, for shrinking from an experiment on another human being, Cheselden lost caste at Court, and was considered pitiable by those who lived on courtly favours.

The argument is taking now the same direction against experiments by man conducted on the lower animals for the purposes of discovery; and when from the history of the past we gather what has been achieved by such experiments, there is but one answer--namely: that such experiments, although they may achieve what was expected of them, were not indispensable. They may have expedited discovery; they may have led to discovery; but they were not indispensable.

--------------------- In the discovery of anaesthesia, general and local, painful experiment on animals has played no indispensable part whatever.

The lower animals have been permitted to share, more than equally with man, in the blessing of anaesthetic discovery, for by it, many of them have been saved the agonies of painful death, but they have (not) been subjected to painful experiment in the course of discovery.... The instauration of general anaesthesia came from experiments made on man alone. There is no suspicion of any experiment on a lower animal in connection with it.... On the contrary, there is a most notable fact in relation to experiments under chloroform made on lower animals, which suggests that if they had ever been relied on,--chloroform would never have been introduced into practice. Flourens, the eminent French physiologist, tried the effect of chloroform on inferior animals, and in consequence of its powerful and fatal influence on them, put it aside as an anaesthetic.

--------------------- There are methods of producing local insensibility to pain which have been tried, and which deserve notice.

In 1862, I made an attempt to carry out local anaesthesia by exhaustion of blood from a part. I noticed that when three round cupping-gla.s.ses were applied to the body very close to each other, the clear triangular s.p.a.ce left free within the rim of the mouths of the gla.s.ses was rendered white, brawny-like and insensible, when the suction of the gla.s.ses was complete. This was obviously due to the local abstraction of blood from the part; and I thought, consequently, that if I could exhaust the blood from the extremity of a limb, the exhausted part might be operated upon without pain.... I tried the process on myself, and finding it succeed, the operation of removing the nail of the greta toe, was tried on a patient, quite painlessly, the patient looking on and feeling nothing. But the proceeding was too long and c.u.mbersome to admit of introduction into practice generally, though it indicated an important principle which may in some future day be utilized. In this research, no experiment on a lower animal was resorted to; I was myself the victim in all preliminary experiments.

--------------------- The most numerous and extensive efforts for local anaesthesia have been those in which extreme cold has been employed to produce the benumbing effect. The earliest applications of cold originated between two and three hundred years ago in the fencing schools of Naples. A Neapolitan professor of training placed crushed ice in a flash of thin gla.s.s, and then applied the chilled gla.s.s to the skin, and held it there until the skin was frozen, in order that the cautery could be employed, or other small operations performed without the infliction of pain. The proceeding must have been most successful, and why it became lost is one of the mysteries of scientific research. It did remain lost until our own time.... I invented for the same purpose the ether spray process, in which a benumbing cold was produced by projecting a volatile liquid like ether or amylene, or a stream of compressed gas ... on the part to be anaesthetized. These methods have been so widely adopted that I need not enter into any description of them. I have merely to say that they were made without any aid of experiments of a painful kind on the lower animals.... The earliest experiment with ether spray was made on my own arm.

--------------------- It is fortunate for me that I have been an eye-witness of the progress made in this department from its practical instauration. I recall the days when operations were performed without the aid either of general or local methods for abolishing pain. I have myself introduced new methods of anaesthesia, generally and locally; I have brought to trial a large number of new anaesthetics. By the invention of the lethal chamber I have had the delightful privilege of removing the taste and pain of death from probably a million of those friends of man, the faithful dogs. I write this not boastfully but truthfully.... Painful experiments have played no indispensible part in the discovery of anaesthesia.

--------------------- It is a curious fact that every method of research which is most enduring, most intellectual and most free from moral evil is farthest away from any and every thing that shocks the conscience or raises a doubt as to necessity, in sensitive minds. If mathematics had to be cultivated through experiments on living animals, it would never have succeeded in unfolding the magnificent mysteries of the universe. The same applies to the work of the science of chemistry, of botany, and of physics generally. In my opinion, every man who studies natural things by experiments on living subjects of any species, feels the truth of what I am saying. I know in my own case, that my mind during such experiments has always been in a different state according to the line of experiment. When the experiment has been conducted on dead or inanimate matter, the return obtained from the labour demanded has always been not only satisfacdtory, but pleasant to the mind. On the contrary, when the experiment has been conducted on living or animate matter, the labour, whether affirmative or negative in its results has never, at any point of it been pleasant. The results may, and often have excited curiousity; they may have been important, and they may have opened the way to new inquiry, but they have never been free of anxiety nor of a sense that whatever came from them, THERE WAS SOMETHING THAT WAS NOT RIGHT. I do not believe I am more sentimental than any of my colleagues; yet I never proceeded to any experiment on a living animal, though to the best of my ability doing everything possible to save all pain, without feeling--what I think is the proper expression,--COMPUNCTION.

--------------------- In the hands of the teacher, it (vivisection) may be rankly abused; of scientific pursuits, it is the one most liable to error; it suggests no end to itself, but seems to grow by what it feeds on, becoming by repet.i.tion and contest more and more extended and multiplied; it is of all pursuits the most disliked by the educated community; it brings its best and most self-sacrificing professors into scorn; and for all such reasons, even if it be occasionally useful, is calculated to lead to what would be esignated intellectual and moral evil. At the same time, let it be understood that I do not include in the criticisms experiments which being devoid of pain, may cause the death even for the service of man. Above all, I could not for a moment object to experiment by a truly competent man for the purpose of inquiry into some great theory that has been leisurely formed, and can be proved or disproved by no other means, as for example, whether an important surgical operation can or cannot be performed for the saving of human suffering or human life.

--------------------- There are some simple and painless experiments which may be demonstrated to any set of pupils, although living animals are the subjects of them. The demonstration of the circulation through the web of the frog; the demonstration of the different natural temperatures of the bodies of animals, including man; the influence of various anaesthetic vapours; the collection of the breath of various animals for the purpose of a.n.a.lysis,--these are all free from objection.... In a word, all experiments which are painless and harmless, are, as I a.s.sume the most humane would admit, free from any charge of error. But when we come to consider the application of experiment of a severe kind as a means of education of pupils who are making a study of physiological problems, there is a reason for hesitation. In my student days, such an experiment was never dreamed of. The professor of physiology would relate the facts derived from experiment, on which some important theories were founded; he would, for instance, explain what experiments were made by Harvey in order to describe the circulation of the blood, but he would not attempt to repeat those experiments in the lecture-room. He would describe, in his remarks on the functions of the nervous system, the researches of Sir Charles Bell, ... but he would never think of repeating Bell's experiment of division of the nerves in the column, alleging forcibly Bell's own objection to its repet.i.tion. It was the same on every point. He would relate the theory; relate the pros and cons; relate possibly his own independent inquiries, or what he had seen experimentally performed by other independent investigators; but with that explanation, he would be content.

--------------------- When I was teaching physiology as I did teach it in a medical school for many years, I abstained for a long period from the direct experimental method. I found no difficulty, and my cla.s.ses worked satisfactorily. The students had the credit of becoming good physiologists, and I am sure there was nothing shirked. In the latter part of my time, I followed occasionally the plan of making a few experiments in the way of demonstration; and although these were rendered painless, the innovation was not the success that was expected.... Intellectually, I do not think my cla.s.ses were a.s.sisted, in the main, by the experimental demonstration. I am sure it limited my sphere of usefulness, by leading me, in the limited time at my command, to omit some parts of physiology of a simpler, less controversial, and more useful kind. I am bound to say that, morally, I do not recall the effect as producing all that could be wished.... I gave up experiments in my cla.s.ses, not from any sentiment, but BECAUSE I GOT ON BETTER WITHOUT THEM. I did not omit the facts derived from experiment, I did not omit the report of my own experimental endeavours; but I omitted repeating, for the mere sake of demonstrating, what seemed to have been proved.... Were I again to deliver a course of physiological lectures to qualified hearers, I should make the experimental demonstrations on living animals as few and far between as was compatible with duty. They would be exceptional of exceptional, and painless from beginning to end.

--------------------- I recommend, as the best method of obtaining the great aims of medicine,--sanitation and the prevention of disease,--first, to make medicine the grand master and teacher of universal cleanliness, and to make everyone of the community a disciple and follower of the same law. The minister of medical art should be prepared to devote his life to this simple duty. He needs no higher calling, no n.o.bler vocation, and a world that knew its own interests should sustain him in the task. At present, the rage is for experimentation, although it seems least wanted, for which rage THE SELFISH AND IGNORANT WORLD IS MOST TO BE BLAMED. The world now, as in the days of Naaman the leper, wants to be healed and protected by elaborate processes, when th esimplest and surest remedy is in its own hands.

From a long experience as a teacher of physiology and of public health, I am convinced that a school or university of preventive medicine would fill an important want. It would tend to make every man and woman a sanitarian, and would help to bring the principles of health into every home. It would be of direct and practical utility; it would instil an exalted comprehension of natural laws, of the advantages of following those laws, and of the danger and folly of setting them at ignorant defiance.... The end would be the accomplishment of the great aim, the development of the health of the people; the art of preventive medicine without inflicting pain on any living thing.

APPENDIX VIII

Since the preceding pages were in type, the United States Department of Agriculture has adopted new regulations governing the inspection of meat. The rules ordered to be applicable to meat derived from animals affected by cancer or malignant disease, are as follows (italics not in original):

Regulation II. Disposal of Diseased Carca.s.ses, etc.

SECTION 7.--ANY INDIVIDUAL ORGAN OR PART OF A CARCa.s.s AFFECTED WITH CARCINOMA OR SARCOMA shall be condemned. In case the carcinoma or sarcoma involves any internal organ TO A MARKED EXTENT, or affects the muscles, skeleton, or body lymph glands even primarily, the carca.s.s shall be condemned. In case of metastasis to any other organ or part of a carca.s.s, or if metastasis has not occurred, but there are present secondary changes in the muscles ... the carca.s.s shall be condemned.

SECTION 9.--All slight, well-limited abrasions on the tongue and inner surface of the lips and mouth, when without lymph-gland involvement, SHALL BE CAREFULLY EXCISED, leaving only sound, normal tissue WHICH MAY BE Pa.s.sED.

ANY ORGAN OR PART of a carca.s.s which ... is affected by a TUMOUR, an abscess, or a suppurating sore shall be condemned; and when the lesions are of such character or extent as to affect the whole carca.s.s, the whole carca.s.s shall be condemned.

It will be seen that the criticism suggested (pp. 269-270) concerning the regulations in force for many years past is not annulled or obviated by the new rules. That which formerly was vague is now more clearly and distinctly set forth. The new regulation most carefully condemns for food purposes "ANY INDIVIDUAL ORGAN OR PART" of a carca.s.s affected with carcinoma or sarcoma (cancer), and such condemnation applies to the carca.s.s, if the malignant disease has involved other parts "to a marked extent." The fact that an animal is suffering from cancer does not of itself compel its rejection for human food. The entire rule would seem to have been drawn so as to permit meat affected by cancer to pa.s.s inspection as "sound, healthful, wholesome, and fit for human food," provided the inspector in charge can declare that in his judgment the malignant disease had not affected the meat "to a marked extent."

In view of the mystery that still surrounds the causation of cancer, this regulation of the Department of Agriculture should be entirely changed. Its basis is regard for financial considerations rather than the public welfare. No part or portion of any animal found to be affected by malignant disease should ever be permitted to be sold for human food. The regulation should read:

Section 7.--Any animal or carca.s.s of any animal found upon inspection to be affected, however slightly, with malignant disease (carcinoma or sarcoma) shall be wholly condemned as unfit for human food.

APPENDIX IX

England and Wales: Deaths of Females from Cancer at Different Age-Periods, and the Ratio to Population, during Twelve Years of this Century.

-------------------------------------------------------------- |Year.|Under 35.|35-44.|45-64.|65 and|Total.|Rate per Million| | | | | | over.| | Population | |-----|---------|------|------|------|------|----------------| | 1901| 695 | 1,811| 8,263| 5,827|16,596| 985 | | 1902| 701 | 1,872| 8,229| 5,972|16,774| 986 | | 1903| 702 | 1,896| 8,490| 6,202|17,290| 1,006 | | 1904| 703 | 1,934| 8,511| 6,448|17,596| 1,010 | | 1905| 719 | 1,904| 8,683| 6,445|17,751| 1,011 | | 1906| 740 | 1,921| 8,945| 6,805|18,411| 1,038 | | 1907| 731 | 1,956| 8,841| 7,018|18,546| 1,035 | | 1908| 658 | 1,943| 9,026| 7,189|18,816| 1,036 | | 1909| 701 | 1,952| 9,466| 7,671|19,790| 1,082 | | 1910| 780 | 2,030| 9,376| 7,578|19,764| 1,070 | | 1911| 730 | 2,080| 9,485| 8,018|20,313| 1,088 | | 1912| 695 | 2,009| 9,926| 8,505|21,135| 1,117 | --------------------------------------------------------------

The foregoing table strikingly ill.u.s.trates the increasing prevalence of cancer in England during the present century. Among women it will be seen that the rate of mortality has increased from 985 to 1,117 per million living within almost a single decade. The slow and yet regular recurrence year after year of a slightly increased mortality from cancer at each period of life after the thirty-fifth year is peculiarly ominous. The connection between increase of cancer and the permitted utilization for food purposes of animals suffering from cancerous ailments is a problem that awaits solution.

APPENDIX X

In the spring of 1915, the Society for the Prevention of Abuse in Animal Experimentation decided to ascertain whether certain of the princ.i.p.al facts connected with vivisection would be freely given if courteously asked. Accordingly, to the directors of laboratories in over a hundred inst.i.tutions of higher learning in America, the following letter was sent by Mr. F. P. Bellamy, the counsel for the Society:

Brooklyn, N.Y.

DEAR SIR,--One of the criticisms urged against the practice of animal experimentation in America at the present time is the laack of any reliable information concerning its extent. Believing that the remedy of this defect lies within the power of the laboratories, I venture to ask whether you would be willing to fill out the accompanying blank form, returning it to me as soon as practicable? If so, I should be glad if you would state whether the figures are based upon a register giving exact numbers or whether they are simply the best estimate you are able to give. If impossible to supply the details asked, can you not give the total number of each species of animals?

I may add that this Society is not opposed to vivisection when the practice is properly safeguarded against any cruelty.

I enclose an addressed and stamped envelope for your reply; and thanking you for whatever information you can afford, I am,

Yours faithfully, FREDERICK P. BELLAMY.

A few details concerning the result of this experimental inquiry may be of interest.

The Department of Physiology of the University of Minnesota reported that the material used for the demonstration of physiological and pathological phenomena before students consisted of 88 dogs, 74 cats, and 420 other animals, making a total of 582 for the year 1914.

The Department of Pathology and Bacteriology of the Medico-Chirurgical College of Philadelphia reported using "about" 124 rabbits and guinea- pigs, chiefly for research purposes. No report, however, was received from the Department of Physiology.