The SRA Symposium - College of Medicine

Papers
Galen experimented on his patients (mostly gladiators, who were essentially slaves) in the course
of treating them to repair injuries. Galen was a Persian dentist, physician, and inventor who designed
many medical and dental instruments that have changed little over the centuries. Several
centuries later, physicians conducting research have frequently used patients, children, the elderly,
prisoners and the mentally ill. These populations were considered available, if not expendable.
Later physicians began to question the ethics of experimenting with these populations, but as
Saunders noted, “In the setting of high mortality and morbidity from infectious diseases, some experiments
with children subjects provided an alternative to an otherwise lethal infection, notably
Jenner’s smallpox vaccination and Pasteur’s rabies vaccine. Successful development of an antitoxin
for the treatment of diphtheria can be credited to the testing of children in Paris orphanages at
the turn of the 19th century. However, the history of children as subjects in human experimentation
is also clouded with research failures and exploitation, particularly involving non-therapeutic
research,” (Saunders, 1996). It was not until the Helsinki Declaration that an ethical method was
created for the research with children..
One of the first “modern” instances of documented research with a human subject was Edward
Jenner’s 1796 smallpox experiment on James Phipps, an eight-year-old boy. The practice of inoculation
had been brought to England by Mary Wortley Montagu (1689-1762), wife of the British
ambassador to Turkey in the second decade of the eighteenth century. A letter to a friend in 1717
outlined the inoculation against smallpox common in Turkey at the time. The problem with this
method (called “engrafting” at the time), which introduces the live and unattenuated smallpox
virus directly into an open sore, was that some patients contracted the full-blown smallpox and
many subsequently died (Internet Modern History Sourcebook. Retrieved March 26, 2005 from
http://www.fordham.edu/halsall/mod/montagu-smallpox.html).
During a smallpox epidemic in 1796, Edward Jenner’s careful observations and clinical documentation
led him to conclude that those who had already contracted cowpox (a mild version of
smallpox that affects the teats of cows and the hands of milkers) did not even get mild symptoms
of smallpox. Jenner, knowing of the engrafting procedure, used it to vaccinate (from vacca, cow)
Phipps, who then developed the mild symptoms of cowpox. Three months later, Jenner challenged
the boy with smallpox. (Note: Pasteur adopted the terms vaccine and vaccination to honor Jenner.)
Subsequent to this experiment, Jenner inoculated his own son. His colleague in the United States,
Benjamin Waterhouse, also used his own children as subjects.
Horace Wells, a dentist, first used nitrous oxide to anesthetize himself to have a wisdom tooth
extracted in 1844. He subsequently experimented on 12 patients, using the gas for tooth extractions.
He began experimenting with chloroform and ether, became addicted to chloroform, and
ultimately committed suicide.
Between 1845 and 1849, J. Marion Sims conducted a series of experiments on slave women, supposedly
without getting their consent (Sartin, 2004). Sims has been called the “father of gynecology,”
yet some have excoriated his experiments and his practice. He devised a crude speculum to
examine women and experimented with surgical methods of repairing vesicovaginal fistulas. He
finally succeeded in repairing the fistula of one slave on the thirtieth attempt. Sims documented
his experiments in the Journal of the American Medical Sciences in 1852. It is noteworthy that
Sims was brought before the New York Academy of Medicine on ethics charges of using paid advertising
and revealing patient secrets (Sartin, 2004). There was not, at the time, any castigation of
his practice of using slaves and poor Irish immigrants in his studies and experimental surgeries.
At about the same time, physicians in France were inoculating patients in hospitals to determine if
secondary syphilis pustules were contagious and debating the ethical nature of these experiments.
Permission to test the contagion theory on prostitutes had been denied in 1852, but later permit-
2005 Symposium Proceedings Book 197