Book review by Anil Pundlik Gokhale
Acres of Skin—Human experiments at Holmesburg Prison, A widely reviewed Book and a true story of abuse and exploitation in the name of medical science, is written by Allen M. Hornblum. It was published in 1998 by Rutledge New York and London. The title signifies the thousands of prison inmates (vulnerable trial subjects) whose skin was the playground for Dr. Kligman (Dr. Albert Kligman, Professor of Dermatology at the University of Pennsylvania. When Dr. Kligman entered the aging prison, he was astonished to see hundreds of inmates walking aimlessly before him and in a flash of second he greedily realized the potentials it held for Experimental Research on the ‘Imprisoned Subjects’. In 1996 Interview with Press, Dr. Kligman imagined himself to be a “farmer seeing a fertile field for the first time”. Allen Hornblum’s Book is an agitating and moving response to the torturous experiments he initiated in Holmes burg Prison, Philadelphia during 1951 to 1974. These abuses “terminated with scandal surrounding the Tuskegee syphilis Experiments”.
The Book is a breakthrough storey narrated by a man named, Allen M. Hornbun, who initially engaged himself to conduct Adult Literacy Program for Holmesburg Prison Inmates in 1971 and for a prolonged period of two decades. In the course of it he developed close friendship with prisoners. During his stay as Literary instructor he keenly observed the deadly abuses inflicted on Prison Inmates The horrors of the stories these Prisoners told him pierced through his mind, heart and whole of his being. After resigning from Philadelphia Sherif’s office in 1994 he decided to undertake his passionate assignment.
Scope & Coverage of the Book- Conspiracy of Silence
The title signifies the thousands of prison inmates (vulnerable trial subjects) whose skin was the playground for Dr. Kligman and Associates to carry out the torturous experiments. A quote by Leo Tolstoy aptly fits the scene,
Holmes burg Prison & Nuremburg Trials
The story centers around Holmesburg Prison—the largest of Philadelphia’s county jails—which became the epicenter of troubling research. It was for many years the professional base for the career of the story’s central character, Dr. Albert M. Kligman, architect of the prison’s experimental research program. Acres of Skin is an attempt by the author to show how American prisoners were exploited in the name of medical science just as senile hospital patients, retarded orphans and other institutionalized populations were exploited in postwar America. The author hopes that this story will finally give voice to a segment of society that volunteered their minds and bodies so that physicians could acquire scientific advancement, fame and fortune; volunteers who were forgotten and tossed aside—in a utilitarian age in which ambition and profit became the ultimate good and the pursuit of scientific knowledge took precedence over the rights of individual human beings.
Hornblum being closely associated with the prison and prisoners has firmly established his Target after through research findings – the prominent manufacturing Giants – particularly those in Dermatology, who were greedy to find out ‘low cost’ Research Facility as extention of Manufacturing Arm. The most dramatic and well-known chapter in the history of research with human participants opened on December 9, 1946, when an American military tribunal opened criminal proceedings against 23 leading German physicians and administrators for their willing participation in war crimes and crimes against humanity. Among the charges were that German Physicians conducted medical experiments on thousands of concentration camp prisoners without their consent. Most of the participants of these experiments died or were permanently crippled as a result. Dr. Robert Rose, department head for Tropical Medicine of the Robert Koch Institute, Germany was convicted on August 20, 1947 for a broad range of ghastly and hideous malaria, mustard gas, bone transplantation, sea water, sterilization and incendiary bomb experiments in concentration camps. However, Dr. Rose was aware of the American medical history and he escaped the hangman’s noose and was given a life sentence. The Nazi doctor stated that America’s experiments with prisoners occurred in the Phillipines, then an American territory in the early years of the 20th century. Another German doctor at Nuremberg, Dr. George August Wetz who was on trial for his high altitude and freezing experiments at Dachau, mentioned in his defense the experiments of Dr. Joseph Goldberger, a U.S public health official involved in experiments involving pellagra. There were close to 2000 deaths in 2 years in the state of Mississipi. As a direct result of the trial, the Nuremberg Code was established in 1948, stating that ‘The voluntary consent of the human participant is absolutely essential,’ making it clear that participants should give consent and that the benefits of research must outweigh the risks. A generation after American judges sentenced Gerhard Rose and his Nazi colleagues in the Palace of Justice, the Nuremberg Code took up residence in America.
Marginalization of ‘Code’ and Breathing Walls
The research for this book began in 1993 and involved a thorough search of government documentation on the Holmesburg medical research program. The author has interviewed hundreds of prisoners, doctors and others who had come in contact with the experiments. Other individuals and resources also contributed mightily to this project. The clinical trials were going on at the prison many years before 1960. Many research experiments were underway at the House of Correction and still more at Holmesburg Prison, where three quarters of the inmate population was involved. All this in spite of the Nuremberg code crafted by American jurists in August 1947 after the Doctors’ trail in Nuremberg, Germany. The code intended to satisfy moral, ethical and legal concepts in the conduct of research and strove to safeguard the health and rights of individuals who chose freely to participate in human research. Rather than embracing the Nuremberg code, the opposite occurred. Society’s marginal people and Black- Negro population were the grist for the medical–pharmaceutical mill and prison inmates in particular became the raw material for profit making and academic advancement. In the eyes of medical practitioners, the well-being of research subjects was not as important as scientific advancement. The Hippocratic ideal of primum non nocere (first of all, to do no harm) seemed to be too restrictive, leading to marginalization of the code and creation of a loophole. Issues such as ‘conflicting obligations,’ ‘factual ignorance,’ ‘culturally induced moral ignorance in hobbling judgments of wrongdoing and blameworthiness inform and impel the writing of this book. The book is an attempt of show how American prisoners were exploited in the name of medical science just as senile hospital patients, retarded orphans and other institutionalized populations were exploited in postwar America. Author has titled the subject as “The walls seemed to be breathing”
Fertile land of SKIN – Gift to Pharmaceutical Giants!
The story centers on Holmesburg Prison, which became the epicenter of troubling research. It was the professional base for Dr. Klingmon, who saw ‘Acres of Skin’ when he first visited the prison. Almost all the inmates agree that those who did succumb to the doctors’ overtures had very little idea, if any of what ingredient, solution, chemical or drug they were actually testing. Informed consent was nowhere in the picture. The Holmesburg Prison was designed such as not a window could be seen. It gave an impression that light too was denied to the unfortunate who spent years of seclusion inside. Dr. Kligman, Ph.D and M.D, University of Pennsylvania began his dermatology research before 1951, when he visited the prison. He selfishly envisioned the skin of the prison inmates to be used for his dermatology trials. He performed trials on anti-obesity drugs, viral infections and bacterial infections. Both white and Negro subjects were made guinea pigs for the studies; however the ratio of the Negro to White patients was highly skewed. There were all kinds of tests—foot powder tests, eye drop tests, face creams, underarm deodorant, toothpaste, liquid diets and more.
The author has included a photograph of an aerial view of Holmesburg prison and the laboratory where the experiments were conducted. The book illustrates the cruelty with the help of photographs of patch tests, malaria tests, vaccine tests. Some of the participants of the experiments, Al Zabala, Withers Ponton, William McCafferty, Roy Williams have posed for pictures and described the ordeal. Kligman’s assistant however adds that Kligman was not a good researcher in true sense. He stopped the experiments ahead of schedule and assumed an outcome that had not been proved. Prisoners were used because they were cheap and nobody gave a damn what happened to them. Pharmaceutical companies sponsored trials of anti-anxiety medicines and tranquilizers and sleeping pills on the prisoners from 1959 to 1965. Klingman’s wife at the time, Dr. Beatrice Troyan, who was a gynaecologist, carried out trials on healthy adult female inmates. Their experiments and data were questioned by the FDA, the individual case reports and data were not maintained in Dr. Klingman’s experiments. Despite this, numerous radioactive isotopes and unprecedented dioxin testing were tested by mid 1960s. The FDA charged Dr. Kligmanin 1966 as the experiments did not enroll the reported number of subjects, studies ended before the estimated time frame, severe adverse drug reactions were not reported, blood samples were drawn from inmates who were not in the prison hospital when the samples were taken, no records for the study were maintained. FDA struck Dr. Kligman’s name from its approved list of researchers who were entitled to test new investigational drugs on human subjects. However, his privileges to investigate new drugs were restored in less than a month by the FDA.
Cowries for Human Breath!
Nevertheless, the Holmesburg medical experimentation program was shut in 1974 and the prison was no longer viable as clinical test on human experimentation and past practices were severely criticized. In 1967, a detailed article about the experiments was published in The Prison Journal by Dr. Heller. It addressed issues such as informed consent, free choice and free will, the element of risk, financial rewards and several other key aspects of the increasingly controversial practice.
Some of the experiments that were underway in the prison included:
A number of tranquilizers, analgesics and antibiotics that were being tested for dosage and toxicity for various pharma companies.
A dental study on 100 inmates testing toothpaste and mouthwashes for toxicity sponsored by Johnson and Johnson. Inmates received $ 20 – $ 25 extra for any blood tests.
A wound healing study for Johnson and Johnson in which absorbency and wound adhesion properties of various dressings were examined. Inmates were paid $ 5 per wound.
An antiseptic lotion study for Johnson and Johnson that utilized 70 inmates
An antiperspirant preparation for Helena Rubenstein that paid 20 inmates at the House of Correction $ 2 per day.
A napkin absorbency study for DuPont that paid 150 female prisoners 50 cents for each used napkin.
Numerous skin sensitization studies including sodium lauryl sulfate solution that left inmates with broken skin, swelling and pustules. Inmates received $ 13 for 28 days.
A conspiracy of silence
For 2 decades — from the early 1950s to the early 1970s, Philadelphia’s Holmesburg Prison played host to one of the largest and most varied medical experimentation centres in the country. Only the inmates and the doctors who experimented on them knew just exactly what took place but, the latter choose not to discuss their medical exploits, the prisoners are not asked. This sad but widespread 20th century phenomenon has much to teach us about our ethical standards and our capacity for human participation.
A question is likely to be asked whether it was legitimate to defy the Disciplinary Norms of the organizational and legal discipline ? Nuremburg trials in which NAZI Doctors performed the horrendous experiments on the prisoners of concentration camps, did provide him the yardsticks to weigh the ethical, moral, psychological and scientific aspects and he decided to break the Silence.
It is argued by few critiques of Hornblum that the comparison is unjustified since NAZI experiments ended only in deaths. They were not paid, the prisoners did not have the right to refuse to the terminal experiments and were not the beneficiaries of the experiments! Secondly vaccination trials were underway in many Prisons and Jails.
However if one realizes that the individuals are confined and have an idea of cost of refusal may result into enhancement of punishment. The lurking compulsive fear amounts only to the dangerous llusion of free will of participants. More importantly the experiments were conducted at the behest of Capitalists- Pharma Giants having hold on the institutions of Justice and may be on the Prison Authorities! Hence his bold exercise to break the silence is stupendous in the Books of Medical History! .
Genesis of Torturous Abuses- For Lowest Cost Pharmaceutical Research
Such experimentation had begun in America in the early years of 20th century. In 1906, Dr. Richard P Strong, an American, performed a series of experiments with the cholera virus upon inmates of Manila prison. The experiments resulted in 13 deaths. In another incident, the Louisiana State Board of Health put Negro prisoners on a steady diet of molasses for 5 weeks to test the effect of sulphuric acid which is used in making molasses. In California, hundreds of prisoners had taken part in bizarre testicular transplants between 1919 and 1922. In 1934, 2 Colorado prisoners were selected to participate in unprecedented tuberculosis drug trials in Denver’s National Jewish Hospital. In 1942, the U.S Army carried experiments of testing beef blood on Massachusetts prison inmates. The best known example of human experimentation in a state prison was in 1944. More than 400 inmates of Statesville had volunteered as experimental subjects for malaria trial. The inmates had to contend with periodic mosquito bites, fever, nausea, vomiting and occasional relapses.
Dr. Andrew C Ivy of the medical school of University of Illinois had conceded in the Nurember’s testimony, ‘prisoners made good subjects because they had nothing else to do except render servive.’ With the arrival of the 1950s and the onset of the Korean War, the federal prison system embarked fully on human experimentation and numerous penal facilities played host to major research initiatives. In 1956 to 1957, 133 inmates at the federal Ohio facility had participated in a study of a low cost oral Polio vaccine.
The number of experiments, test subjects and prisoners involved in medical research grew steadily and the tests were as diverse as the prison systems. Research on cancer which had become the deadliest disease confronting Americans, was carried out on Ohio prison inmates. They volunteered to receive needle injections in the form of live cancer cells. One of the most egregious examples of penal medical abuse is the case of Austin R Stough, an Oklahoma physician who sold blood plasma extracted from prisoners and using the prisoners as subjects for repeated, wide scale drug testing. This led to increasing incidence of viral hepatitis. Several deaths occurred every month. One of the inmates described this as ‘They are dropping like flies out here.’
Genocide of overwhelming Blacks- dropping like flies out here
By 1973, the pressure on state and federal penal systems that performed medical research on prisoners had reached critical mass. Critics were growing rapidly in number and their criticism were increasingly hostile. Jessica Mitford devoted a revealing chapter entitled, ‘Cheaper than Chimpanzees’ to prison experimentation, placing particular emphasis on America’s departure from the spirit of Nuremberg in its use of prisoners as research subjects.
What was once a lucrative growth industry in medicine had become a victim of its own excesses and changes in community ethics.
An article appeared in the April 1981 issue of Correction magazine on the Holmesburg prison experiments. It spoke about a dangerous chemical named dioxin and described the story of one of the inmates, Al Zabala. The Environmental Protection Agency (EPA) received a flood of correspondence from concerned inmates and former prisoners ever since the story had been published. Mr. Verald Keith Rowe, director of toxicological affairs and health and environmental research contacted Dr. Kligman and began the first scientifically monitored tests of dioxin in humans. The experiment started in late 1965 and was completed in early 1966. However, African–American prisoners were represented in disproportionate numbers. The Philadelphia Tribune devoted several news articles to the genocide as the test population was over-whelmingly black and non-white.
In January 1974, the Philadelphia prison system’s Board of Trustees decided to abolish the program in the prison. Solomon McBride, longtime administrator of the program found the termination of the once thriving unit hard to accept. But there were other illegal activities going on in the prison. Several assaults in the Philadelphia Prison system were an epidemic. To save money, operators of the projects used inmates as laboratory assistants.
The disproportionate wealth and power in the hands of a few inmates led to favouritism, bribery and jealousy among the guards. Also, African–American inmates were particularly fearful of genocide and suspected that black prisoners were recruited for the more dangerous experiments.
The first significant legal problem regarding human research at Holmesburg arose when 9 Black male subjects volunteered to test the safety and tolerance of a new medication. Jerome Roach of these 9 subjects developed various symptoms of physical illness 4 days after taking pills different from those described to him. His condition grew serious enough for him to be transferred to the hospital where he remained for several weeks. He had permanent liver damage. He sued Dr. Kligman, Ivy Research laboratories, the prison system and the city for $ 400,000 for violation of his civil rights.
Subversion of Philosophy of Science and turn to Barbaric Sadism
Miamonides, a 12th century philosopher, who followed the footsteps of Aristotle, as Physician had advised his colleagues to treat patients not merely as means to the acquisition of knowledge, but as valuable in themselves. 800 years later, another physician, Dr. Kligman advised his colleagues and taught his students that ‘rules don’t apply to geniuses. An uninformed and desperate group of prisoners met an unrestrained and ambitious doctor and largest, nontherapeutic, human research factories. Even more remarkable is how such a large and intricate operation in a public facility went so long unnoticed and unchallenged. Several reasons for this lapse in social and political sensitivity suggest themselves, beginning with this nation’s failure to take seriously the Nuremberg code. According to the American medical community, this code of medical ethics was designed for Nazi physicians, ‘written for the specific purpose of preventing brutal excesses from being committed or executed in the name of science. It was argued that the prison research in America was ideal and all subjects had volunteered in the absence of coercion in any form. The physicians interviewed for this book report that Nazi medicine was a horrible but distant medical aberration and the moral superiority of American research was the received norm which Nazi doctors were judged. American Medical Association adopted its own ‘Rules of Human Experimentation.’ The doctors who entered Holmesburg Prison a few short years after Nuremberg were conditioned to see the mass of idle humanity before them as a ‘fertile field’ of investigating opportunity. Dr. Kligman framed it as prisoners had become a new experimental resource, they had become ‘acres of skin.’
The healing/harming paradox that enveloped Kligman and his medical research program left its mark literally and professionally on all its participants. As Kligman’s research program, which was established to investigate diseases and to train residents in dermatology grew, it is supposed to have strayed from its mission. Couple of Reviewers have identified the value of the Book as locating the roots of the Evil in the reduction of Science to a “pragmatic and Utilitarian course” In fact In time, no protocol was too risky, no relationship too troubling, no code immune too violating. Kligman’s blatant medical abuses allow the Holmesburg experiments to be compared to the barbarity and sadism of the Auschwitz and Dachau. In fact the Author holds far more radical view that the intended experiments were subversive from the beginning till end. Uneducated and isolated, desperately short of money, the inmates were an easy target of medical mercenaries looking for test subjects. Today, the physical and phychologial scars from their days as only disdain for the eminent men of medicine who offered them ‘money for a piece of their skin.’ Many former test subjects and their families now regard the medical profession as torturers rather than healers.
Lessons – Unparallel Sacrifices by Helpless Prisoners.
The book seems to be an attempt by the author to summarize the inhuman treatment towards the prisoners and to make the readers aware of their fundamental rights. We could summarize the sufferings of the test subjects by knowing their current statuses. An inmate of the dioxin test, Al Zabala, later realized that he was exposed to a potential carcinogen then. Roy Williams lost all his hair after participating in a shampoo trial. Johnnie Williams has many scars and skin discolouration after the tests. The most sensitive and helpless reaction was of an inmate named Withers Ponton who endured dozens of experiments during his 3 years at the prison. In need of money he went to the H block each morning and asked, “Do you need me today?” This shows the helplessnessof the subjects and the forced volunteering carried out in the prison. It is because of the innumerable sacrifices made and pain undergone by the inmates that we use so many drugs and formulations as treatment today.
The book aptly describes the inhuman medical malpractices going on in America since early 20th century. It opens our eyes to the world of unimaginable experiments carried out by the ‘messiahs’ whom we call doctors.
The Nuremberg Code (1947) and later the Declaration of Helsinki (1964) are important in the history of research ethics. They deal with the fundamental principles of respect for the individual, their right to make informed decisions regarding participation in research. The Declaration of Helsinki was replaced by Good Clinical Practices from October 2008.
Acres of Skin makes us aware of our fundamental right of willing consent as potential test subjects and at the same time emphasizes how the law should be in favour of the common man, rather than pharmaceutical giants who sponsor the clinical trials and the medical industry who is part of such wrongdoings.
Case Studies of Torture through Toxic Radiation
Below are a few examples of the clinical trials
Al Zabala, a 27 year old American prisoner was a guinea pig for the testing of chemical agents in Holmesburg Prison. He believes he was given an injection of a substance 10 times stronger than LSD. He was real subdued and quiet for a month after the test. He had problems swallowing food and a constantly dry throat. For a few years his body would periodically break out in ‘strawberry reashes.’ He began to wonder if the tests had altered the biochemistry and chromosomes of his body after he read newspaper articles describing the extent of Holmesburg medical studies.
William Robb at the State Correctional Institution at Pittsburgh had participated in 3 different types of tests, 2 of which were nicknamed ‘The Patch Tests’ by inmates. These were new experimental products not yet released in general public. The inmate was exposed to a sunlamp once a day for 30 days. After about 5 days of exposure, some section of the skin were burnt a deep brown and the skin started to peel, itch and blister.
In August 1938, 4 prisoners were cooked to death in a simulated oven over a protest. The prison was called the ‘torture chamber.’
In the early 1960s, radioactive iron and phosphorus were used on inmates of Colorado State Penitentiary to study characteristics of red blood cells during periods of rapid red cell formation and iron deficiency. Radiation experiments in Oregon and Washington form 1963 to 1973 were designed to measure the effects of radiation on male reproductive system. 5 or more testicular biopsies were carried out on each subject and they were vasectomized at the end of the program. Subjects endured skin burns, pain from biopsies, testicular inflammation and bleeding.
Lompoc (California) and Stafford (Arizona) were holding weightlessness experiments, simulated by extended bed rest for NASA at the U.S Public Health Service Hospital in San Francisco. They were conducted between 1969 to 1975 and more than 50 individuals had taken part. They were forced to wear compression suits and endure endless blood and calcium tests, numerous radioactive isotope injections.
Worse than NAZIS?
Intelligence Review (EIR) Volume 26, Number 31, August 6, 1999 – Marianna Wertz Author quotes Hornblum that he believes what was done to the men in Holmesburg Prison was actually worse than what the Nazis did to slave laborers in their concentration camps. “Frankly, I think it pales in comparison to what the men went through here. They were really used as guinea pigs. They were brought out of a cage, they were dosed up with all sorts of things, that were either placed on them, or that they were made to swallow or injected with. They rarely or ever knew what it was, or what the ramifications would be. So, I think it’s actually worse than the use of slave laborers.” Americans drafted the Nuremberg Code, and Americans should make sure that it is implemented here, and that those who suffered from its violation are given justice. We say that we would not stand for less from others—what about America itself?
These are the burning remarks and eye opening comments. Crying voices of those who fell victims to NAZI gruesome experiments have continuously surfaced in the Book like background music of a sad Piano. The reciprocal relationship of Holmesburg prison and NAZI experiments and their semblance has been brought out to create empathy of readers. However this moving story goes beyond it as scathing criticism of Bourgeoisie – capitalist system or capital in General, irrespective of Nations which treats Prisons as extended ‘cost reducing’ Research Facility. The Book written way back in 1998 articulates pains of those who have suffered for our Benefits and exposes the ruthless face of modern capitalism!
Acres of Skin—Human Experiments at
Holmesburg Prison: A True Story of Abuse and Exploitation in the Name of Medical Science
Anil Pundlik Gokhale is an Engineer by profession and have been a reader and student of Marxist and Freudian literature for last four decades.He has been a professional translator of medical and other literature from English to Marathi. As a non regular writer on political literature he has always been attempting to intigrate Psychology and Marxism.He has recently published books ‘Condensation And Condescension In Dreams And History: Essay – From Sigmund Freud To E P Thompson’ by Author House London. Psychoanalysis & A- Historical Story of GENGHIS KHAN, Author House- London