Patient H.M.

by Luke Dittrich

  Then there were the so-called freezing experiments. Throughout the war, the German Luftwaffe lost numerous aircraft over the North Atlantic. Many of the aircrews successfully parachuted from their planes before impact, only to freeze to death in the cold ocean waters. Some were pulled from the ocean while still alive but died anyway due to hypothermia. At Dachau, the Nazis decided to conduct research into the limits of cold endurance, as well as the most efficient and effective ways to rewarm hypothermic human beings. These particular experiments were conducted mostly in a part of the station known as Block Number Five. There the Nazis had installed a large wooden basin, two meters long and two meters high. The basin was filled with water, and ice was added until its temperature dropped to 37.4 degrees, a few degrees above freezing. Prisoners were immersed either naked or while wearing the standard flight suits of the German air force. Their temperatures were monitored through rectal thermometers, and they were typically kept in the basins until their bodies were chilled to 77 degrees, although they almost always lost consciousness at 89 degrees. Eventually they were removed, and attempts were made to resuscitate them. Some were wrapped in blankets, while others were subjected to more aggressive rewarming tactics. As Pacholegg told his interrogators, “another experiment conducted with these half-frozen, unconscious people was to take a man and throw him in boiling water of varying temperatures and take readings on his physical reactions from extreme cold to extreme heat. The victims came out looking like lobsters. Some lived, but most of them died. Scientifically I cannot understand how they lived.”

  At the end of the interview, the army interrogators asked Pacholegg if there was anything else he wished to add about his time chronicling the activities at the Experimental Station. There was, he told them.

  “I remember,” he said, “[that] any report I made out almost always ended with the remark ‘Experiment successful, but the patient died.’ ”

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  The nine-page transcript of Anton Pacholegg’s interrogation eventually became document number 2428 in the first trial conducted by the United States Nuremberg Military Tribunals after the war. The Doctors Trial, as it became known, had twenty-three defendants, all of them Nazis, most of them doctors, and the opening line of the prosecution’s opening statement was blunt and clear: “The defendants in this case are charged with murders, tortures, and other atrocities committed in the name of medical science.” Indeed, “medical science” in Germany had been so corrupted, according to the chief prosecutor, that it demanded the coining of new words to describe it: “This case and these defendants have created this gruesome question for the lexicographer. For the moment, we will christen this macabre science ‘thanatology,’ the science of producing death.”

  The evidence against them was overwhelming. Apart from the damning eyewitness testimony from men like Pacholegg, the Nazis had meticulously documented their activities, producing a vast paper trail. In 1941, for example, a Luftwaffe physician named Sigmund Rascher, who would oversee the Experimental Station at Dachau, wrote a letter to Heinrich Himmler, the head of all medical services within the Third Reich. In the letter, Rascher lamented the fact that within the air force “no tests with human material had yet been possible for us, as such experiments are very dangerous and nobody volunteers for them.” Rascher also noted that the tests “theretofore made with monkeys had not been satisfactory” and inquired whether concentration camp inmates might be provided for him to use instead. An assistant of Himmler’s immediately wrote back, informing Rascher that “prisoners will, of course, gladly be made available.”

  Two years later, on February 17, 1943, Rascher sent an update to Himmler, this one including a short report on a new venture. The report, titled “Experiments for Rewarming of Intensely Chilled Human Beings by Animal Warmth,” chronicled the use of Gypsy women shipped in from the Ravensbrück concentration camp in northern Germany to warm some of the frozen male prisoners during the hypothermia experiments. “In eight cases the experimental subjects were then placed between two naked women in a spacious bed. The women were supposed to nestle as closely as possible to the chilled person. Then all three persons were covered with blankets.” The report included graphs depicting the relative rates of rewarming when one or two women were used, and noted that in certain rare cases the frozen men recovered sufficiently to perform sexual intercourse. In the cover letter to this report, Rascher mentioned that he was beginning to experiment with freezing the prisoners by simply “leaving them outdoors naked from 9–14 hours” in midwinter instead of using the ice water method, but that he believed such experiments would be better conducted elsewhere. “Auschwitz is in every way more suitable for such a large serial experiment than Dachau because it is colder there and the greater extent of open country within the camp would make the experiments less conspicuous (the experimental subjects yell when they freeze severely).”

  The prosecution stressed that despite the clear monstrousness of the experiments, the monstrousness of the Nazis who conducted the experiments might be harder to recognize. In many cases, they did not conform to our usual understanding of what a monster is and isn’t. “These defendants did not kill in hot blood, nor for personal enrichment,” the chief prosecutor said. “Some of them may be sadists, who killed and tortured for sport, but they are not all perverts. They are not ignorant men. Most of them are trained physicians, and some of them are distinguished scientists. Yet these defendants, all of whom were fully able to comprehend the nature of their acts, and most of whom were exceptionally qualified to form a moral and professional judgment in this respect, are responsible for wholesale murder and unspeakably cruel tortures.”

  How was this possible?

  The answer, according to the prosecution, was that the guiding principles of the Nazi state had caused a “moral degradation” of the German people and that moral degradation led to the physical degradation of other human beings. The crimes of the Nazi doctors, the prosecution argued, “were the inevitable result of the sinister doctrines which they espoused.”

  The trial lasted for almost a year. By the time it was nearing its end, the prosecution had effectively demonstrated that the Nazi “investigators had free and unrestricted access to human beings to be experimented upon” and had treated them like disposable “human guinea pigs.”

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  The research conducted by the Nazis at Dachau and other concentration camps was perhaps history’s most brutal and sustained example of inhumane human experimentation, but it wasn’t the first. The broken have always illuminated the unbroken, and throughout history that breaking was often intentional. Around 300 B.C.E., in Alexandria, Egypt, two doctors named Herophilus and Erasistratus pioneered the craft of human dissection, and although most of their subjects were dead, there is evidence that some were not. Chronicling the work of those two doctors, the Ancient Greek historian Celsus described how, since “pains, and also various kinds of diseases, arise in the more internal parts, they hold that no one can apply remedies for these who is ignorant about the parts themselves; hence it becomes necessary to lay open the bodies of the dead and to scrutinize their viscera and intestines. They hold that Herophilus and Erasistratus did this in the best way by far, when they laid open men whilst alive—criminals received out prison from the kings—and whilst these were still breathing, observed parts which beforehand nature had concealed, their position, color, shape, size, arrangement, hardness, softness, smoothness, relation, processes, and depressions of each, and whether any part is inserted into or is received into another.” A couple hundred years later, during the first century B.C.E., the Egyptian pharaoh Cleopatra supposedly ordered her own series of experimental vivisections on humans. At the time, there was a debate about whether male fetuses developed more slowly in the womb than female ones. In an attempt to settle the question, Cleopatra is said to have had a number of her own handmaidens forcibly impregnated, then dissected at various stages of their pregnancies while still alive.

  Although vivisec
tion was a rare extreme, the history of medical research is filled with unsettling experiments involving human beings. For example, in 1796, after noticing that workers on dairy farms almost never contracted smallpox, the British physician Edward Jenner decided to test a theory that this was because they had previously been exposed to the relatively benign disease known as cowpox. He made a series of small incisions in the arm of his gardener’s son, eight-year-old James Phipps, then introduced the pus from a local milkmaid’s cowpox blisters under Phipps’s skin. During the following week, Phipps developed the mild fever, aches, and pains characteristic of cowpox, then recovered fully. Six weeks later, Jenner lanced his arm again and this time administered him smallpox, at the time the most deadly disease known to man. Phipps did not develop any symptoms, so Jenner exposed him again and again, twenty times in all, to no effect. Finally, Jenner concluded that he had discovered a smallpox vaccine. His discovery would change the world, leading not just to the eradication of smallpox but to the creation of modern immunology and the subsequent development of vaccines for hundreds of other diseases. Today it’s possible to make a persuasive argument that Edward Jenner saved more human lives than any single person in history. Taking this into account, perhaps it’s easy to argue that jeopardizing the life of an eight-year-old boy was acceptable.

  In other cases, however, the experiments that led to medical breakthroughs were more troubling, and the calculus becomes murkier.

  In 1845, a South Carolinian physician named J. Marion Sims undertook a four-year-long program of experimental surgeries on fourteen black women, all of whom were slaves and most of whom he had purchased and installed on his property as live-in test subjects. His surgeries were aimed at developing a treatment for vesicovaginal fistula, a potentially fatal complication of childbirth that was common at the time, and he operated on some of his slaves as many as thirty times each. Anesthesia was still in its infancy, and he didn’t use any. After much trial and error, and many deaths from infection, Sims developed an effective surgical approach. Only then did he begin operating on white women. Sims went on to become president of the American Medical Association and is widely considered the father of modern gynecology. To this day, visitors to Central Park in New York City can see the larger-than-life bronze statue of him standing right across the street from the New York Academy of Medicine.

  And in 1932, the U.S. Public Health Service launched the Tuskegee Syphilis Experiment, a long-term study that over the next four decades monitored the effects of syphilis on a group of black Alabaman men who were never told they’d been infected. Syphilis is fatal when left unchecked, but easily treated: The researchers could have saved many lives with a few prescriptions of penicillin, but they chose not to, preferring to observe the disease rather than cure it.

  For most of human history, our attitudes toward human experimentation were strictly utilitarian. If the scientific benefits were great enough, then almost any cost was justified. In an 1895 article called “The Relative Value of Life and Learning,” a prominent University of Chicago chemist named E. E. Slosson summed up this attitude when he wrote that “a human life is nothing compared with a new fact in science.” He scoffed at those who held that “the aim of science is the cure of disease, the saving of human life,” and argued that “quite the contrary, the aim of science is the advancement of human knowledge at any sacrifice of human life.”

  But the horrific experimentation laid bare during the Doctors Trial at Nuremberg demonstrated the “moral degradation” that such a mindset could lead to. And to those who cared to look, Nuremberg also cast a harsh light on the ethics of scientific research being conducted elsewhere. Indeed, the chief defense of the Nazi scientists was to argue that what they did was, at a fundamental level, what scientists had always done, and that while their experiments may have been uniquely brutal, human experimentation of one sort or another was ubiquitous. It was hard not to concede that they had a point.

  On August 20, 1947, the tribunal delivered its verdict. To the surprise of no one, all twenty-three defendants were sentenced to die by hanging. However, in a concession that the Nazi experiments were perhaps only different in kind, not character, from medical research conducted elsewhere, the tribunal’s verdict also included a new declaration of the fundamental principles that they believed should govern research on humans from that day forward. The rules became known as the Nuremberg Code, and although the code did not itself hold the force of law, it was a vastly influential template and inspired a spate of new laws related to the conduct of medical experiments worldwide.

  This is the Nuremberg Code:

  1. Required is the voluntary, well-informed, understanding consent of the human subject in a full legal capacity.

  2. The experiment should aim at positive results for society that cannot be procured in some other way.

  3. It should be based on previous knowledge (like an expectation derived from animal experiments) that justifies the experiment.

  4. The experiment should be set up in a way that avoids unnecessary physical and mental suffering and injuries.

  5. It should not be conducted when there is any reason to believe that it implies a risk of death or disabling injury.

  6. The risks of the experiment should be in proportion to (that is, not exceed) the expected humanitarian benefits.

  7. Preparations and facilities must be provided that adequately protect the subjects against the experiment’s risks.

  8. The staff who conduct or take part in the experiment must be fully trained and scientifically qualified.

  9. The human subjects must be free to immediately quit the experiment at any point when they feel physically or mentally unable to go on.

  10. Likewise, the medical staff must stop the experiment at any point when they observe that continuation would be dangerous.

  While the Nuremberg trials were still in process, Charles Burlingame invited a man named Dr. Nolan Lewis to give a talk to his staff at the Institute of Living. Lewis was the “psychiatric adviser” to the international war crimes tribunal, and the talk he gave, which took place on January 15, 1947, was titled “Impressions of the Psychological Factors in Nazi Ideology.” Lewis, in his analysis of the Third Reich, took the long view.

  “In order to understand any ideology or social development one must return to the operation of primary laws or elementary principles,” he said. “Anywhere along this great cosmic chain of evolutionary events…pathological events can and do happen. We detect and study pathological patterns in cells, tissues, organs, and in individuals, at chemical, physical, and psychological levels, and in higher cultural and political fields the so-called social pathological phenomenon appears often in actively destructive ways, throwing some parts of normal evolution either into a cul-de-sac or into an actual regression process, which retards or actually destroys some portion of civilization, the amount affected depending upon the size and virulence of the pathological tendency. The Nazi ideology was one of these pathological streaks.”

  Lewis explained to the audience that the social pathology of Nazism led to a remarkable transformation in the German people, leaving them with “a complete absence of human compassion as we understand it.” He described how they were thus able to commit their crimes “indifferently, without undue emotional reactions,” and that they were so morally debased that “the mud and other filth of the concentration camps affected the Nazis much more than human suffering.” He then told the asylum staff that any attempts to understand the Nazis by seeking slivers of common ground were doomed to fail.

  “We must stop thinking,” he said, “that these Nazis are anything like us in their attitudes, thinking, or feeling.”

  After Lewis’s talk, the employees of the Institute of Living went back to work, tending to the asylum’s guests. In some ways, things had changed since the end of the war. There were no longer mandatory periodic blackouts, and the budget had expanded, allowing for the hiring of new staff and the launch of new construction proj
ects. In other ways, however, things were the same as they’d always been. The asylum remained a place of constant activity, and Burlingame continued to encourage a multipronged approach to the treatment of his guests, prescribing the widespread application of heat, water, and electricity, not to mention the cold steel of my grandfather’s surgical tools. He also continued to embrace new experimental treatments whenever they arose.

  For example, at around the time of Lewis’s visit, Burlingame hired a new staff psychiatrist named M. Marin-Foucher, who had recently developed a novel therapeutic technique. It involved a coffin-shaped cabinet much like the one in the Pyretotherapy Room, but in this case it was designed to have an opposite effect. Guests would be made to lie in the cabinet, strapped down between layers of blankets that contained rubber tubing. A freezing solution would then be pumped continuously through the tubing while a thermometer placed in the guests’ rectums monitored their temperature. Once it dipped below 93 degrees, guests tended to remain unconscious until they were removed from the cabinet, between forty-eight to seventy-two hours later.

  Marin-Foucher considered the treatment to be promising though inconclusive, and he eventually published his results in the asylum’s in-house scientific journal. His paper was titled “Hypothermia: A New Treatment for Mental Illness,” and like most academicians, he was careful to credit the relevant work by prior researchers. In this case, his scientific antecedents were clear: In the first paragraph of his report, he noted that he had been inspired by “the studies of the Germans on hypothermia in World War II.”

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