Subjected to Science: Human Experimentation in America Before the Second World War

The College of Medical Science, the basic sciences, the clinical sciences, progress in medical science, . . . ; since medicine became inextricably linked with science in the nineteenth century, the vast majority of books describing the linkage have focused on the improvements that it provided. Susan Lederer in Subjected to Science has looked at another, equally important dimension, and has done so in an engaging and scholarly way. This is a very important book that deserves to be widely read.

The story told by Lederer is the largely unknown story of the role of human subjects in biomedical research during the half-century 1890–1940. She carefully chronicles the origin of concern with and opposition to nontherapeutic experimentation with human subjects by the antivivisection community of the late nineteenth and early twentieth centuries. The development of an attitude that would encourage nontherapeutic human experimentation, called somewhat loosely “human vivisection” by these opponents, was one reason for the opposition to unregulated animal experimentation. Proponents of the new medical science used the vehicle of organized medicine—particularly the newly reorganized and invigorated AMA—to defend the profession against the charges of the antivivisectionists and, more important, to assure the public that the research being done was ethical and beneficial in the prevention and treatment of disease. The leaders of research medicine orchestrated a collaborative effort by researchers, editors, and interpreters of medical science to describe research in the least offensive words, while providing the positive interpretation of the benefits derived. Yet despite efforts to achieve a high ethical standard in research activity, there were repeated examples of human use that attracted continued opposition. Given the widely recognized difficulties in achieving a unanimous standard, the profession increasingly pointed to the social value of the research and, most importantly, the heroic nature of researchers who put themselves at risk in the effort to help humanity.

This book is remarkably rich in observations that call for further study, and I expect that dozens of papers will emerge from Lederer’s pioneering work. For example, on p. 74 she notes (without reference) that early-twentieth-century physicians questioned the meaning of informed consent, given the inequities inherent in the physician-patient relationship. These concerns, in company with the Supreme Court’s 1904 recognition (in Jacobsen v. Massachusetts) of technical authority in public health issues of compulsion, might lead to significant new understanding of the social authority of the profession as it emerged in the early twentieth century.

At the same time, there are examples of unanswered questions that result from the author’s failure to take into account the state of medical knowledge in relation to a particular subject, as in her treatment (pp. 81–84) of Noguchi’s 1911 efforts to develop a cutaneous diagnostic test for syphilis. Her discussion of opposition to the Rockefeller scientist’s work is based on the inadequate public knowledge of the STD problem in the second decade of the century; however, this lack of general knowledge still requires a careful examination of the knowledge-base of the researchers and the professional supporters of those researchers.

Lederer almost never places the research she describes in its contemporary medical context—material that would frequently have made the work easier to understand. For example, in discussing the inability of twentieth-century practitioners to challenge their presumptive tuberculosis vaccine subjects with live TB germs (p. 88), she notes that early-nineteenth-century physicians challenged the early smallpox-vaccinated individuals. However, she does not note that inoculation was an accepted standard of care prior to the introduction of vaccination. Similarly, she lets stand Rufus Cole’s explanation of the public acceptance of hospitals based on their research contributions as if she accepted this as valid (p. 124). This lack of contextual richness in the medicine will require those who choose to use this excellent monograph...