Were Cheap and Available: Prisoners as Research
Subjects in Twentieth Century America
of the British Medical Journal and
(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.
content is also freely
available on PubMed Central.
Studies, Temple University,
Philadelphia, PA 19122-2585, USA
M Hornblum, instructor
to: 7100 Bustleton Ave, Philadelphia, PA 19149, USA
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
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
20 August 1947 Gerhard Rose, one of Germany's most
physicians, stood in the prisoner's
at the Palace of Justice in
Nuremberg, Germany, awaiting his sentence for "murders, tortures, and
atrocities committed in the name of medical science." Dr Rose,
the department head for tropical
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
one point in the trial when the chief prosecution witness, Dr.
Andrew C. Ivy of the medical school of
University of Illinois, underscored the basic principle "that human
experimental subjects must be
Dr Rose and his defence counsel vigorously objected,
that the United States was
of similar medical practices and giving several examples to
support this contention.1
experiments on prisoners in US
Nazi doctor's first example of American complicity
concerned the medical experiments of Dr Richard P
a series of studies in 1906 with "cholera virus upon inmates of the
Bilibid Prison in
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
of cholera serum.2,5
who later became professor of tropical medicine at Harvard
not deterred by the
and continued experiments on
Philippine prisoners. His beriberi experiments six years later also
in death, but survivors were compensated with cigars and
German physician on trial for his life at Nuremberg, Dr. Georg
August Weltz, the chief of the
for Aviation Medicine in
Munich, offered the name of another American doctor who used prisoners
behalf of medical science. Dr Joseph Goldberger, a public health
official, sought to unravel the mystery
pellagra, a deadly and at
times disfiguring disease that was particularly virulent in the
parted company with medical colleagues who blamed the
disease on everything from poor
and personal habits to
spoiled corn and flawed hereditary traits for the disease. He believed
was due to the provincial and poor diet in the south, which
supplied calories but not protein.
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
on a dozen inmates of Rankin Farm prison. His plan was
"induce pellagra in
males, the one group in the population
that statistics had shown was the least likely to contract
volunteers after a promise of a pardon where gradually weened away from
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
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
American prisons, but those few cases paled in comparison to what
Nuremberg.Though American doctors, lawyers, and justices at the
denounced the German medical
establishment for horrific and pseudoscientific experiments
prisoners, the American medical community disassociated itself from
the implications of the trial and
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
towards "the brutalities of Nazi
Moreover, even though American jurists enumerated
rights principles to
safeguard the lives of research subjects-and imposed the death penalty
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
were considered too valuable.
that incarcerated criminals had new utility as
human guinea pigs did not emerge until the
efforts at using prisoners were not embraced by the orthodox medical
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
"transplanting testicles from recently executed convicts to senile
and devitalized men."8
By 1920, the
been altered so that "animal glands were substituted for
the human and were grafted to the
testes." Dr L L Stanley, the resident physician at San
Quentin Prison (California), where the operations were
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 substance;
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
on everything from "general athenia" to renewed "sexual stimulation."
He also believed
"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
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 at
Denver's National Jewish Hospital in 1934. After years of trials on
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
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
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
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
they didn't 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
oddities of dubious worth.
Surprisingly, the practice received a big boost with the outbreak of
the second world
With American soldiers fighting and dying in
Europe and the South Pacific, a whole new industry utilising
material" was about to emerge that would shape researchers' behaviour
for decades to come.
second world war
By the summer
of 1942, American prisoners in state penal systems
had embarked on a series of dangerous
injections of blood from beef cattle as a new source of plasma,
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
One of the
more widely publicised prison experiments during the war
years, and one that was mentioned
the Nuremberg Doctors' Trial, was the series of malaria
Stateville Penitentiary in
400 prisoners were
involved in this two year study investigating treatment and purported
One popular account of the experiment was Nathan
Leopold's book, Life Plus 99 Years. An
participant in the
dangerous study, Leopold was one of the famous killers in the 1924
and Loeb case.
proudly proclaimed that even though the inmates had to contend with
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
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
institutions as a site of such
What had once been a small, underf-
unsophisticated cottage industry had
a well financed,
programme investigating avant garde
cures, and treatments. Human
had been legitimised and
become the guinea pigs of
scores of inspired researchers.
opposition to such
was scant The
overriding goal was to win the
war in Europe
and Asia; everything else was
including research ethics and the
of American fighters
life and limb daily; at the very
least, lawbreakers could contribute to the war effort with
commitment And they did. One close
described it as
"another shining light in the galaxy of wartime achievement" by
once the war was over, there was no decline of medical
experimentation in prisons. Battlefield victories were replaced
medical triumphs as the focus of governmental concern, and prisoners
were once again the subjects of
choice for research.
eradication of disease had become the enemy, and postwar budgetary
priorities supported this societal
example, in the last
year of the war, the National Institute of Health received about $700
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
research" by Professor DavidRothman, this
new era of laissez-faire attitudes in the laboratory
ushered in a frenzy for research on prisoners that lasted
for over a
that a "utilitarian ethic" was able to dominate the field of human
experimentation because "the benefits seemed so much greater
costs" and because "there were no groups
or individuals prominently
opposing such an ethic.21
who contributed greatly to the postwar acceptance of
prisoners as appropriate subjects for research was Andrew C.
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 war, including
those working in penal institutions. No American prisoner, Ivy
reiterated, had ever been experimented on against his
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
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 clinicalexperiments.
Ivy articulated three "principles" for
ethical prison research: if "the consent of the subject was obtained";
if the experiment was based on "animal experimentation"; and if it was
persons" the medical procedure was acceptable.22 For American
researchers anxious to utilise the thousands of
behind bars, Ivy's emphasis on acquiring voluntary consent from
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 implemented.23
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
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 utilitarian
The result was
tremendous expansion in prison experimentation in
postwar America. Federal prisoners, for
enlisted in a broad range of clinical studies that
athlete's foot, histoplasmosis, infectious hepatitis, syphilis, and
amoebic dysentery, and in additional malaria experiments.25
State prisoners were
be equally valuable and were soon
utilised for studies of syphilis, malaria, influenza, viral hepatitis,
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
the 8 year
old girl were laid side by side, "their circulatory
linked together with rubber tubing," in the hope
that her cancerous "poisoned blood" would be cleansed as it proceeded
through his body. Unfortunately, the risky
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
headlines because of the perceived dangers of the tests. The Ohio state
allowed researchers from the
Sloan-Kettering Institute for Cancer Research to inject over 100
cancer cells. The study was designed to examine "the
natural killing off process of the human body";
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
to work with unrestrained, unrestricted" test subjects
(C. Southam, personal communication).
experiments during the 1960s
By the 1960s,
new drug testing regulations mandated by the Food and
Drug Administration permitted
human experimentation as large pharmaceutical companies
sought stronger relationships with
institutions. Phase I drug testing now required larger pools of
healthy subjects for non-therapeutic
and using hospital patients was thought to be inadequate.
Prisoners, on the other hand, were in
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
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
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
some even died in an extended series of drug tests
and blood plasma projects in Oklahoma, Arkansas,
volume plasmapheresis programme attracted great
commercial interest, but his poorly trained staff and shoddy
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
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
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
end of prison experimentation
By the early
1970s, social and political indifference to human
experimentation had begun to shift. Events as
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
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
experiments, lawmakers and the
general public had been chastened by the
cavalier use of vulnerable populations for non-therapeutic medical
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
that represented the public's acceptance of human
experimentation had not only swung, but had
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
Sabin, for example-resisted the new ethical
current and continued to argue that prisoners were "a stable, long time
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
quarter century of unrestrained use of prison inmates as cheap
and available raw material for medical
the once widely accepted practice had come to an end.
Victims of scientific and social forces,
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
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