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Against Their Will
The Secret History of Medical Experimentation on Children in Cold War America
By Allen M. Hornblum, Judith L. Newman, Gregory J. Dober
Palgrave Macmillan Copyright © 2013 Allen M. Hornblum, Judith L. Newman, and Gregory J. Dober
All rights reserved.
THE AGE OF HEROIC MEDICINE
"At Their Best, Medical Men Are the Highest Type Yet Reached by Mankind"
There are few today who would not immediately recognize the names Babe Ruth, Jack Dempsey, and Red Grange. Their iconic status as sporting greats from what is usually referred to as the Golden Age of Sports is arguably unrivaled, a testament to their physical accomplishments and their stature as Mount Olympus–caliber athletic competitors as well as the sports-obsessed era in which they competed. Even a horse, Man o' War, managed to cement his name and stirring victories into the consciousness of adoring sports fans during the 1920s.
Books, newspaper and magazine articles, and movie theater newsreels repeatedly showcased the physical talents and athletic exploits of the era's much-celebrated champions, so it was no surprise that comic books would devote numerous titles and issues to their accomplishments on the gridiron, diamond, and track.
Surprisingly, however, in addition to splendid athletes, courageous crime detectives, and all-powerful science fiction characters, some of the world's leading medical and scientific minds would grace the titles and covers of children's magazines. They would not only add some cultural and substantive heft to the lowbrow but extremely popular newsstand magazines but also underscore the rising status of physicians and highlight the importance of the medical profession in contemporary society. By World War II, for example, gallant generals and daring soldiers were cover-story topics, but brilliant medical sleuths on the cutting edge of new treatments and vaccines held their own and often shared newsstand space with them.
American medicine had come a long way. As Harvard sociologist Paul Starr has written, prior to the twentieth century the role of doctor did not confer a clear and distinct class position in American society. In the nineteenth century, most medical men were often no more than autodidacts, veterans of an apprenticeship system that required no formal education. The result was a profession that had little status and modest earning potential.
By the early years of the twentieth century, however, the prestige and income potential of the medical profession had witnessed enormous gains; in fact, medicine had become a highly desirable career choice. In 1925 physicians ranked just behind bankers and college professors and just ahead of clergymen and lawyers according to a survey of high school students and teachers. By the 1930s medicine had jumped to the top of every occupational category and would remain there. Only one position exceeded physicians: "Justice of the U.S. Supreme Court."
Sobering accounts of medical sacrifice and the excitement of triumphant discoveries, as well as an appreciation of medical history, took off in the 1920s. Profiles of the men and women who played a role in that history became a key part of the narrative. One of the first and arguably most influential of the medical success story chroniclers during this period was Paul de Kruif. Though little remembered today, de Kruif was instrumental in illuminating the challenges and sacrifices made by the great men and women of science who had committed their lives to fighting disease and pestilence.
After serving in World War I and participating in the hunt for Pancho Villa in Mexico, de Kruif earned a doctorate in bacteriology at the University of Michigan and became a research fellow at New York's prestigious Rockefeller Institute, a well-recognized powerhouse of scientific research and talent. De Kruif also nurtured a side interest; he wanted to become a writer. He began to chronicle what he was observing in the lab and writing illuminating vignettes about the men who were searching for the answers to age-old mysteries. De Kruif began with a series of anonymous articles in Century magazine in 1922. The articles underscored his conflicted feelings about the profession, both the hero worship and his increasing disenchantment. At Rockefeller, de Kruif rubbed shoulders with the elite of contemporary medical research. Many were Nobel Prize winners or soon would be. But despite the great minds and many awards associated with the Rockefeller Institute, de Kruif was overcome with a growing skepticism. As he would recount decades later, "The years wore on but the hoped-for parade of cures did not come off. Could it be," he asked, "that the slot machine had turned out to be a one-armed bandit ...?"
Weighed down by doubts and personal issues that included a failing marriage and regrets on leaving a child behind, de Kruif took a leave of absence from his assignments at Rockefeller in 1922 and began to write about medical research as he knew it and the great men and institutions that were involved in the battle against disease. Not all of it would be positive. One 1922 magazine project, initially titled "Doctors and Drugmongers," and his first book, Our Medicine Men, illuminated the pretentiousness and naïveté of American medicine. The works drew public interest, at least one lawsuit, and his prompt dismissal from the Rockefeller Institute. He was fired "for irreverently daring to write — a la Henry Mencken — spoofing Rockefeller science and for disrespect to medicine's holy of holies."
De Kruif considered his firing a "self-inflicted kick in the teeth" that spurred his move from science to journalism. Before tackling another subject on his own, he would perform the duties of a scientific aide-de-camp and idea repository for one of the literary giants of the period, the novelist Sinclair Lewis. The much-admired literary storyteller was searching for his next project when he met de Kruif. The relationship between the master novelist and the aspiring journalist would prove critical to one of Lewis's greatest literary triumphs. As Lewis listened to de Kruif's stories of the institute, he increasingly perceived the seeds of a storyline, one that had all the makings of a landmark work. De Kruif agreed. In the hands of a master storyteller like Lewis, de Kruif's account of scientific research at the highest levels could prove an "epic of medical debunkology."
The result was the American classic Arrowsmith,a Pulitzer Prize–winning novel whose heroic leading man was a dedicated research scientist, supposedly "the first of consequence in American literature." According to medical historian Charles Rosenberg, Martin Arrowsmith was a "new kind of hero, one appropriate to twentieth century America." The book's unusual theme and hero not only appealed to aspiring science buffs but, surprisingly, also resonated with the American public.
De Kruif and Lewis had created the protagonist Martin Arrowsmith, a genuine scientist with a religious-like fervor for the truth. His tightly conceived and meticulously coordinated experiments would be untainted by professional aspirations, commercial distractions, or government restrictions. Contemporary American life — particularly as it was evolving in the Roaring Twenties — was pervasive in its demeaning and degrading materialism and its endless status seeking; even pure science had been infected and tarnished. Lewis and de Kruif had their character rebel against such corrupting influences and seductions; they ultimately had Arrowsmith jettison his family and material considerations for a simpler life that was consistent with pure scientific research.
Arrowsmith was a great success, won its author a Pulitzer and even greater notoriety, and was made into a successful Hollywood film. It would also give most Americans their first peek into the culture of American medicine.
With the Lewis project completed, de Kruif was in search of a project of his own.
"One day," as he would later write, he began thinking about "Leeuwenhoek, the first of the microbe men." Soon he had completed a manuscript containing the contributions of twelve great scientists, from Antonie van Leeuwenhoek, who first peered into a fantastic new world of microscopic organisms in the seventeenth century, to Paul Ehrlich, who discovered his groundbreaking 606 medicinal recipe that effectively destroyed spirochaetes bacteria, or the cause of syphilis, three centuries later. They were microbe hunters in de Kruif's book of that name, brilliant, dedicated men of science who had conquered insidious diseases and saved the lives of untold millions. In recounting their difficult quests, their self-sacrifice and intellectual challenges, and finally the grandeur of their discoveries, de Kruif transformed a piece of staid laboratory history into a series of true adventure sagas that appealed to readers who normally had little interest in science.
Harcourt Brace — the book's publisher — initially was not optimistic about de Kruif's "off-beat opus"; medical research tomes weren't big sellers. The company thought it would be "lucky if it sold-out its first printing," a modest 2,800 copies. As de Kruif happily recalled years later, "Immediately upon publication the sales of the book exploded in our faces." Favorable reviews from prominent literary and social critics propelled it along. "One of the noblest chapters in the history of mankind," roared Henry Mencken. "A book for those who love high adventure, who love clear, brave writing," wrote William Allen White. The book shot up the nonfiction bestseller lists during the summer of 1926, quickly passed 100,000 copies in sales, and "became one of the big nonfiction books of the decade." De Kruif had written the right book at the right time for a hero-worshipping age.
Much of its success, no doubt, was de Kruif's accessible, breezy style of historical portraiture. By combining biographies of serious-minded men who had labored long and hard to break new scientific ground and a writing style that was more typical of tales of the Old West, de Kruif discovered the secret to seducing young and old readers alike.
De Kruif was not just an academic who could craftily turn a phrase and tell an interesting story; he recognized nuance, grappled with moral boundaries, and valued visionary leadership, even when those attributes were sometimes in conflict. He appreciated Walter Reed's creative and intrepid pursuit of the fearsome mosquito that spread death and disease throughout the tropics, but he also recognized that the great American physician was rolling the dice with other people's lives — in some cases the lives of friends and colleagues. As de Kruif wrote of Reed and his deadly experiments, "To make any kind of experiment to prove mosquitoes carry yellow fever you must have experimental animals, and that meant nothing more nor less than human animals." De Kruif did not always sugarcoat unpleasant facts; he let readers know that Reed was involved in human experimentation and that such research often ended tragically. There was no getting around it, de Kruif informed his readers; that was the nature of human research. It was "an immoral business."
The thousands of Americans who read Microbe Hunters in the 1920s and the decades that followed were told of the trade-offs involved with such historic undertakings. Solving an age-old riddle that had snuffed out millions of lives wasn't child's play; experimenting with tropical diseases was a serious and deadly affair. Reed, according to de Kruif's account, understood that challenge — he had "not one particle of doubt he had to risk human lives" to solve the mystery of the deadly yellow fever. "'You must kill men to save them!'" argued the great microbe hunter. "Never was there a good man," wrote de Kruif admiringly, "who thought of more hellish and dastardly tests."
But de Kruif went out of his way to assure readers that men like Dr. Reed and his ilk were above suspicion, guiltless. Yes, giving test subjects yellow fever would be considered "murder" by some, but Reed's zealousness and his willingness to put people at risk were understandable. It was crucial that medical science determine, by any means necessary, if mosquitoes caused yellow fever.
The book caused many Americans to confront the unattractive calculus of medical research. It wasn't pleasant, but it paid dividends — thousands of innocent lives eventually would be spared. De Kruif's heroic accounts of great men doing dangerous things would also illuminate the majesty as well as the desperation of the various test subjects, the experimental guinea pigs. With a strong whiff of American chauvinism, de Kruif praised those educated Westerners who understood the risk, appreciated the historic moment, and offered themselves as test subjects. They were accorded heroic status. "'We volunteer solely for the cause of humanity and in the interest of science,'" says a brave army private, according to de Kruif, during one solemn scene. "'Gentlemen, I salute you,'" replies an obviously appreciative Major Reed. In the author's eyes, all such military volunteers were "first-class, unquestionable guinea-pigs, above suspicion and beyond reproach."
But many more would be needed to test the theory and solve the deadly riddle. The "dastardly experiment" designed by the "insanely scientific Walter Reed" required ever more subjects. If there weren't enough "Americans who were ready to throw away their lives in the interest of science," then "there were ignorant people," those just arriving in "Cuba from Spain and who could very well use two hundred dollars." In describing the induction of these "mercenary fellows" as test subjects, although they would suffer the same raging fevers, agonizing discomfort, and fits of vomiting and diarrhea, they never came off as quite as gallant as the American soldiers and doctors who volunteered for the research program.
De Kruif's triumphant account of the landmark yellow fever experiments and the driven — almost heartless — attitude of the chief medical investigator resonated with readers just as Martin Arrowsmith's fictional quest for scientific purity had captured the hearts and minds of readers a year earlier.
The message of Microbe Hunterswas clear: Great men like Pasteur, Reed, Theobald Smith, and Paul Ehrlich were a rare breed. But for all their skill, training, and dogged pursuit of that deadly microbe or magical elixir, their mission was infinitely complex, the challenges multifaceted, and the trail of disease and death a daily occurrence. They had to make difficult decisions, decisions that might look cavalier and callous to the casual observer. And yes, on occasion they'd even appear cruel and "less human" in the eyes of some. But if society was to benefit in the long run, these extraordinary men of medicine — arguably the best and brightest of their class — must have the freedom to operate and to proceed unencumbered by moral tastes of the moment or by bureaucratic constraints. Granted, some unfortunate souls would lose their lives in these roulette-like experiments, but then, as de Kruif argued, "the microbe hunters of the great line have always been gamblers." He insisted that we not dwell on the negative but think of the heroic mission — focus on "the good brave adventurer and the thousands he has saved."
And many did just that.
IN ADDITION TO THE DOUBLE SHOT of medical research triumphalism offered by Lewis and de Kruif, 1926 would witness a literary trifecta as Harvey Cushing's biography of William Osler, the most admired physician in English and American medicine, would win the Pulitzer Prize. Rarely had literary and historical works about the culture of medicine and the men behind the healing arts so captivated readers. The staid professions of medicine and medical research had received a shot in the arm, if not a dramatic makeover. Those in the business of the "wholesome adventure" genre took notice and subsequently propelled popular heroic narratives to include men in white lab coats alongside athletic champions, battlefield heroes, and comic book characters.
Comic books, however, were only one of many entertainment and informational sources that sought to capture the drama of dedicated doctors combating deadly diseases and laboratory researchers vanquishing public health maladies in the hope of discovering miracle cures and saving lives. As early as the 1920s, "medical history images, and stories came to be widely disseminated in popular books and magazines, commemorations, Hollywood films, children's literature, radio dramas, schoolbooks, corporate advertising, and the then-brand-new genre of comic books."
The phalanx of media sources trumpeting the devoted and occasionally death-defying actions of medical researchers heightened the image of the medical profession not only with better-educated Americans but with general readers and their children. Moreover, it also helped solidify those middle decades of the twentieth century as the Golden Age of American Medicine and foster a greater public appreciation for doctors, their profession, and their soaring status in society. For doctors to be lionized with sports icons like Lou Gehrig and war heroes like General George S. Patton was no small achievement.
Excerpted from Against Their Will by Allen M. Hornblum, Judith L. Newman, Gregory J. Dober. Copyright © 2013 Allen M. Hornblum, Judith L. Newman, and Gregory J. Dober. Excerpted by permission of Palgrave Macmillan.
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