They Were Cheap and Available: Prisoners as Research
Subjects in Twentieth Century America
Author: Allen M. Hornblum
Digitization of the British Medical Journal and its
(1840-1996) was completed by the U.S. National Library of
in partnership with The Wellcome Trust and the Joint Information
SystemsCommittee (JISC) in the UK.
This content is also freely
available on PubMed Central.
Department of Urban Studies, Temple University,
Philadelphia, PA 19122-2585, USA
Allen M Hornblum, instructor
Correspondence to: 7100 Bustleton Ave, Philadelphia, PA 19149, USA
From the early years of this century, the use of
prison inmates as raw material for medical
experiments became an
increasingly valuable component of American scientific research
Testimony by American medical experts at Nuremberg allowed American
researchers to believe that the Nuremberg Code was
directed only at Nazi scientists Postwar
American research grew rapidly
as prisoners became the backbone of a lucrative system
Uneducated and financially desperate prisoners volunteered" for medical
ranged from tropical and sexually transmitted diseases
to polio, cancer, and chemical warfare
On 20 August 1947 Gerhard Rose, one of Germany's most
physicians, stood in the prisoner's
dock at the Palace of Justice in
Nuremberg, Germany, awaiting his sentence for "murders, tortures, and
other atrocities committed in the name of medical science." Dr Rose,
the department head for tropical
medicine of the Robert Koch Institute,
was on trial along with 22 of his medical colleagues, for perpe-
"ghastly" and "hideous" experiments on concentration camp prisoners
during the war.1
At one point in the trial when the chief prosecution witness, Dr.
Andrew C. Ivy of the medical school of
the University of Illinois, underscored the basic principle "that human
experimental subjects must be
volunteers," Dr Rose and his defence counsel vigorously objected, arguing
that the United States was
guilty of similar medical practices and giving several examples to
support this contention.1
Early experiments on prisoners in US
The Nazi doctor's first example of American complicity
concerned the medical experiments of Dr Richard P
Strong, who performed
a series of studies in 1906 with "cholera virus upon inmates of the
Bilibid Prison in
Manila." The Philippine Islands experiment on
prisoners already sentenced to death resulted in 13 fatalities
eventually attributed to a bottle of bubonic plague serum having been
substituted mistakenly for a
bottle of cholera serum.2,5
Strong, who later became professor of tropical medicine at Harvard
was not deterred by the
error and continued experiments on
Philippine prisoners. His beriberi experiments six years later also
resulted in death, but survivors were compensated with cigars and cigarettes.
Another German physician on trial for his life at Nuremberg, Dr. Georg
August Weltz, the chief of the
Institute for Aviation Medicine in
Munich, offered the name of another American doctor who used prisoners
on behalf of medical science. Dr Joseph Goldberger, a public health
official, sought to unravel the mystery
of pellagra, a deadly and at
times disfiguring disease that was particularly virulent in the
Goldberger parted company with medical colleagues who blamed the
disease on everything from poor
sanitation and personal habits to
spoiled corn and flawed hereditary traits for the disease. He believed
pellagra was due to the provincial and poor diet in the south, which
supplied calories but not protein.
Milk, vegetables, and
fresh meat, he theorised, were the missing staples.
To prove his theory, Goldberger convinced Gover nor Earl Brewer of
Mississippi to allow him to perform
an experiment on a dozen inmates of Rankin Farm prison. His plan was simple: to
"induce pellagra in
white adult males, the one group in the population
that statistics had shown was the least likely to contract
disease."6 The inmate
volunteers after a promise of a pardon where gradually weened away from
normal diet and given a steady supply of cornbread, sweet potatoes, grits, and rice. Complaints grew as the
from lethargy, dizziness, and pains in their backs, sides, and legs.
Soon skin lesions began to
appear and the "red flame" of pellagra was
identified on each of the test subjects. The governor kept his
and pardoned the men. One test subject said he had been through "a
thousand hells," whereas
another swore he would choose a "lifetime of
hard labor" rather than go through such a "hellish experiment"
As part of their defence strategy, the Nazi doctors on trial at
Nuremberg named other examples of dubious
human experimentation in
American prisons, but those few cases paled in comparison to what
after Nuremberg.Though American doctors, lawyers, and justices at the Doctors' Trial
physicians and denounced the German medical
establishment for horrific and pseudoscientific experiments
prisoners, the American medical community disassociated itself from
the implications of the trial and
from the subsequent code of ethical
research principles-the Nuremberg Code-that all doctors were supposed
to observe. By the end of the war, America's rapidly emerging scientific dominance was not to be hamstrung
by a code of
medical conduct that was perceived by the American Medical Association
to be directed
specifically towards "the brutalities of Nazi
physicians."7 Moreover, even though American jurists enumerated
10 human rights principles to
safeguard the lives of research subjects-and imposed the death penalty
seven members of the Nazi medical hierarchy for violating such
principles-self interest, utilitarianism,
the aura of science militated against the adoption of the Nuremberg
Code in the United States. Research
subjects, particularly prisoners,
were considered too valuable.
The realisation that incarcerated criminals had new utility as
human guinea pigs did not emerge until the
second world war. Earlier
efforts at using prisoners were not embraced by the orthodox medical
which thought such practices were the preserve of
unsophisticated medical eccentrics investigating offbeat
theories. For example, between 1918 and 1922 a doctor in the state
prison system in California
was "transplanting testicles from recently executed convicts to senile and devitalized men."8
By 1920, the
procedure had been altered so that "animal glands were substituted for the human and were grafted to the
recipient's testes." Dr L L Stanley, the resident physician at San
Quentin Prison (California), where the operations
recommended that the material to be used was "best taken from a ram,
goat or boar" aged
between a year and 18 months. Hundreds of San
Quentin inmates received injections of animal testicular
some received a piece of ram's testicle the size of a silver dollar,
which was implanted into the
scrotum or abdominal wall. The innovative researcher
on prisoners was convinced that the procedures had
a "decided effect"
on everything from "general athenia" to renewed "sexual stimulation."
He also believed
he was "fortunate" the operations-which he called
"practically painless and harmless"-could be carried out
in a prison
because of the regimented lifestyle of prisoners.8
One prewar experiment that was less dramatic than testicular
transplants, but captured the public's attention due to extensive
newspaper coverage, was the series of tuberculosis experiments
Denver's National Jewish Hospital in 1934. After years of trials
animals, Dr H J Corper claimed a tuberculosis vaccine he had been
developing was "now ready for trial on human beings."9
from the Colorado Penitentiary were selected as
the guinea pigs from
the 800 who had volunteered for the risky experiment after Governor
Edwin C Johnson offered executive clemency to the survivors. Carl
Erickson, one of the lucky inmates chosen, said: "I don't want to die,
I volunteered to help so I could
get out of here."10
Mike Schmidt, his
partner in the experiment, was equally suspicious of his good fortune:
"I don't exactly relish the
idea of making an experiment out of
myself."11 Though Schmidt became
very ill during the course of the
experiment, newspapers eventually proclaimed "Tuberculosis test a
success" and the men were granted their freedom.12
all reviews of the Denver experiment were favourable. One critic,
concerned about crime than disease, commented: "We fail to see any
excuse for releasing upon the community two life term fellows because
get tuberculosis when inoculated with a prepara tion of
For the most part, however, experiments on prisoners during the early
decades of the century were uncommon
medical oddities of dubious worth.
Surprisingly, the practice received a big boost with the outbreak of
world war. With American soldiers fighting and dying in
Europe and the South Pacific, a whole new industry
material" was about to emerge that would shape researchers' behaviour
for decades to come.
The second world war
By the summer of 1942, American prisoners in state penal systems
had embarked on a series of dangerous
medical experiments, including
injections of blood from beef cattle as a new source of plasma,
and experiments with sleeping sickness, sandfly
fever, and dengue fever.14,15 Federal prisoners were recruited
participate in medical experiments that ran the gamut from exposure to
gonorrhoea and malaria to induction
of gas gangrene.16
One of the more widely publicised prison experiments during the war
years, and one that was mentioned
prominently at the Nuremberg Doctors' Trial, was the series of malaria studies at
Stateville Penitentiary in
Illinois. Over 400 prisoners were
involved in this two year study investigating treatment and purported
of malaria. One popular account of the experiment was Nathan
Leopold's book, Life Plus 99 Years. An
enthusiastic participant in the
dangerous study, Leopold was one of the famous killers in the 1924 Leopold
and Loeb case. He
proudly proclaimed that even though the inmates had to contend with
bites, raging fevers, nausea, vomiting, blackouts,
endless untested medicinal potions, and occasional relapses,
squawked. They all took it like men."17
The highly publicised Stateville Prison malaria experiments
much public praise. An editorial in one newspaper proudly wrote that
"these one-time enemies to
society appreciate to the fullest extent
just how completely this is everybody's war."18
The war years had become the transforming moment for human
in America and particularly
for penal institutions as a site of such
endeavors. What had once been a small, underf-
unsophisticated cottage industry had
blossomed into a well financed,
research programme investigating avant garde
cures, and treatments. Human
experimentation had been legitimised and
prisoners had become the guinea pigs of
choice for scores of inspired researchers.
Public opposition to such
was scant The overriding goal was to win the
war in Europe and Asia; everything else was
secondary, including research ethics and the
issue of consent Millions
of American fighters
were risking life and limb daily; at the very
least, lawbreakers could contribute to the war effort with
commitment And they did. One close
observer described it as
"another shining light in the galaxy of wartime achievement" by
Curiously, once the war was over, there was no decline of medical
experimentation in prisons. Battlefield victories
were replaced by
medical triumphs as the focus of governmental concern, and prisoners
were once again the
subjects of choice for research.
The eradication of disease had become the enemy, and postwar budgetary
priorities supported this societal
mission. For example, in the last
year of the war, the National Institute of Health received about $700
which had climbed to $36 million by 1955, and over 10 times that
just 10 years later. In 1970, $1.5 billion
was awarded to some 11 000
grant applicants, nearly a third of them performing experimentation.20 Called
"the gilded age of
research" by Professor David
Rothman, this new era of laissez-faire attitudes in the laboratory
ushered in a frenzy for research on prisoners
that lasted for over a
quarter century.20 Rothman argues
that a "utilitarian ethic" was able to dominate the field
of human experimentation because "the benefits seemed so much greater than the
costs" and because "there
were no groups or individuals prominently
opposing such an ethic.21
One individual who contributed greatly to the postwar acceptance of
prisoners as appropriate subjects for research
was Andrew C. Ivy, an
eminent researcher and vice president of the University of Illinois
Medical School. Asked by
the American Medical Association to be its
representative at the Nuremberg Doctors' Trial and the prosecution's
key witness on American medical ethics, Ivy testified to the high
ethical standards of American researchers during the
those working in penal institutions. No American prisoner, Ivy
reiterated, had ever been experimented
on against his will. Defence
counsel strongly objected to Ivy's sanitised portrayal of American
prison research and peppered him with questions about numerous penal
experiments both before and during the war.22
Dr Ivy remained intransigent; he did not believe that official coercion was necessarily inherent in a prison
environment and restated
his belief that prisoners in the United States
had a choice as to whether they should participate in clinical
experiments. Ivy articulated three "principles" for establishing
ethical prison research: if "the consent of the subject
if the experiment was based on "animal experimentation"; and if it was directed by
qualified persons" the medical procedure was acceptable.22 For American
researchers anxious to utilise the
thousands of potential subjects
behind bars, Ivy's emphasis on acquiring voluntary consent from experimental
subjects represented a seal of approval. In fact, the seal of approval
came less than a year after the Doctors' Trial,
when the journal of the
American Medical Association published a "special article" that
endorsed the "ideal"
medical practice used in the Stateville malaria
experiments, where Ivy claimed his principles had been
Although the Doctors' Trial culminated in the establishment of the
Nuremberg Code-whose first principle emphasised that the human subject
"should have legal capacity to give consent ... exercise free power of
choice, without the
element of force ... constraint or coercion"-the
American medical Community either claimed ignorance of the
document or ignored it.24
The first principle of the code seemed to preclude the use of
prisoners, but Ivy, America's
star witness on medical ethics, extolled
the virtues of just such scientific practices. The muddy ethical waters
that resulted from the dual codes allowed American medical researchers
to follow their own moral guidelines or
The result was tremendous expansion in prison experimentation in
postwar America. Federal prisoners, for
example, were enlisted in a broad range of clinical studies that included
athlete's foot, histoplasmosis, infectious hepatitis, syphilis, and
amoebic dysentery, and in additional malaria experiments.25
State prisoners were
considered to be equally valuable and were soon
utilised for studies of syphilis, malaria, influenza, viral hepatitis,
and flash burns "which might result from atomic bomb attacks.26,30
of these postwar medical initiatives were scientifically unsound and
placed prisoners at great risk. Louis Boy, for example, a prisoner
in Sing Sing (New York), volunteered to become a human blood cleaning
agent for a young "girl dying of cancer."31 For 24 hours the prisoner
and the 8 year old girl were laid side by side, "their circulatory systems
linked together with rubber tubing," in the
that her cancerous "poisoned blood" would be cleansed as it proceeded
through his body. Unfortunately, the
risky experiment proved
unsuccessful and the girl died. However, public interest in the human
drama resulted in the prisoner, a lifer, receiving a Christmas gift from the governor-his freedom.32
In the 1950s, American prisons hosted an increasing variety of
non-therapeutic medical experiments, some of
which captured national
headlines because of the perceived dangers of the tests. The Ohio state
for example, allowed researchers from the
Sloan-Kettering Institute for Cancer Research to inject over 100
with live cancer cells. The study was designed to examine "the
natural killing off process of the human body";
inmates were informed they faced "no grave danger. Any cancer that took would spread slowly
... and could be
One physician intimate with the study four decades ago recently said
that prisoners were a
"stable group of people" that contributed to the
"assurance of continuity." Researchers, he argued, clearly found it
more difficult to work with unrestrained, unrestricted" test subjects
(C. Southam, personal communication).
Prison experiments during the 1960s
By the 1960s, new drug testing regulations mandated by the Food and
Drug Administration permitted
increased human experimentation as large pharmaceutical companies
sought stronger relationships with
penal institutions. Phase I drug testing now required larger pools of
healthy subjects for non-therapeutic
experiments, and using hospital patients was thought to be inadequate.
Prisoners, on the other hand, were in
abundance and, as one pharmaceutical company researcher commented,
"guaranteed to show up" (G. Wachs,
The rush to acquire prison testing sites, combined with a relaxed
ethical atmosphere and little governmental
oversight, provided a
financial opportunity for some opportunistic physicians, while at the
same time jeopardising
the health of the unsophisticated test subjects.
One of the best examples of this unfortunate but all too common
scenario was the controversial career of Dr. Austin Stough. Claimed to
have grossed close to $1 million a year, Stough-and the pharmaceutical
companies he worked for profited handsomely, while the inmates he used
made ill and some even died in an extended series of drug tests
and blood plasma projects in Oklahoma,
Arkansas, and Alabama.34
Stough's high volume plasmapheresis programme attracted great
commercial interest, but his poorly trained staff
and shoddy operations
resulted in inmate volunteers receiving the wrong blood type and as
many as 30 inmates
a month contracting viral hepatitis. "They're
dropping like flies out here," wrote one alarmed inmate to the outside
world.34 Throughout the 1960s the use of prisoners as research subjects remained
popular as prisons tested
everything from tropical diseases and
respiratory infections to infectious hepatitis and "pain tolerance
In rare cases, some prisons became super-markets of investigatory
opportunity for zealous physicians representing aggressive private and
public sector institutions. In Holmesburg Prison, for instance, a
county facility in Philadelphia,
an array of studies explored
everything from simple detergents and diet drinks to dioxin and
chemical warfare agents. The long list of sponsors included major
pharmaceutical houses and diverse entities such as RJ Reynolds, Dow
Chemical, and the United States Army.40
The end of prison experimentation
By the early 1970s, social and political indifference to human
experimentation had begun to shift. Events as
disparate as drug
scares (thalidomide), hospital embarrassments (the use of 22 senile
patients for live cancer cell studies at the Jewish Chronic Disease
Hospital in New York City), alarming articles in professional journals
(Dr Henry Beecher's analysis of unethical medical studies41), and popular books (Jessica Mitford's Kind
and Usual Punishment39)
contributed to a growing repugnance towards scientific experiments on
unwitting and institutionalised populations. By 1973, with the
controversial revelations surrounding the Tuskegee syphilis
and the general public had been chastened by the
cavalier use of vulnerable populations for non-therapeutic medical
Legislation was beginning to be introduced "to limit the use of prison
inmates in medical research"42;
prison administrators were voicing "serious doubts about the ability of
prisoners to volunteer for any form of medical research"43; and prison research programmes were being
terminated, especially the more controversial
ones such as the decade-long studies in Oregon and Washington that
irradiated the testicles of prison inmates.44
The pendulum that represented the public's acceptance of human
experimentation had not only swung, but had
swung decisively. Even
physicians who had been long time advocates of the practice were forced
to concede that scientific investigators and drug companies could
continue their work without the use of prisoners.45
Dr. Albert Sabin, for example-resisted the new ethical
current and continued to argue that prisoners were "a stable,
permanent study group" perfect for medical research.46 By 1975, only 12 state prison systems were
hosting medical experiments, and their numbers were declining rapidly.47 Less than a year later, the
federal government announced the end of medical research on federal
After a quarter century of unrestrained use of prison inmates as cheap
and available raw material for medical
experimentation, the once widely accepted practice had come to an end.
Victims of scientific and social forces,
prisoners were still shunned, but they were no longer seen as the human
equivalent of laboratory guinea pigs.
researchers initially resisted this new medical ethic, it gradually
encompassed the entire medical community and terminated any thought of
"the wealth of test material that there is in penitentiaries."49
Conflict of interest: None.
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