The history of medicine is filled with grisly stories that push the boundary between brave medicine and irresponsible cruelty. But one story doesn’t just strain that boundary, it stamps all over it. The story of Dr Roberts Bartholow and his pioneering work on the human brain is recognized as a terrible example of unethical conduct performed in the name of science.
This is a bit of a gross one. Readers high in curiosity but low in “stomach” should be warned.
Who was Dr Roberts Bartholow?
Dr Roberts Bartholow was born in New Windsor, Maryland, in November 1831. He was educated locally at Calvert College where he studied the liberal arts before heading to the University of Maryland to study medicine.
After qualifying as a doctor in 1852, Bartholow took up post-graduate work in clinics and hospitals in Baltimore and then became an assistant surgeon in the US Army during the American Civil War. In 1862, he married and then, in 1864, he had his first child which resulted in him leaving the army. Bartholow then took up the position of Professor of Medical Chemistry at the Medical College of Ohio, in Cincinnati.
Although recognized as intelligent and erudite, Bartholow was far from popular. He had an abrasive personality and was regarded as cold and cynical. Quick with his tongue and even quicker with his pen, he alienated many of his colleagues through sarcastic criticism.
It seems his aggressive ways led him to take up a position at the Good Samaritan Hospital, where he set up his own laboratory. It was here that he started to experiment with the assumed healing powers of electricity, which he believed could be used to treat a variety of disorders and conditions. As classically “mad scientist” as this may sound, the belief was common in the 19th century when enthusiasm for all things electric was practically shocking.
In Bartholow’s laboratory, electricity was not just entertainment, it was the future.
“By the intelligent liberality of a gentleman of this city, Good Samaritan Hospital now contains an electrical room furnished with all the appliances needed for the practical uses and scientific study of electricity,” he wrote in a journal he co-founded.
But if he was going to be able to use this modern marvel, he was going to need some willing patients to work with.
Bad decisions and worse outcomes
The Good Samaritan Hospital was where Bartholow first encountered Mary Rafferty, who entered his laboratory in 1874.
Not much is known about Mary outside of what Bartholow wrote in a subsequent report. She was an Irish immigrant in her early 30s who suffered from a strange problem. As a child, Mary had apparently fallen into a fire which severely burnt her head. The wound was so bad that she was forced to wear wigs from then on, but over time, a “piece of whalebone” in her wig had rubbed away at her scalp – it went from being a sore to an open and infected ulcer.
By the time Mary met Dr Bartholow, the wound was so bad that the flesh and bone of her skull had been worn away revealing “a space 2 inches [5 centimeters] in diameter, where the pulsations of the brain are plainly seen”.
The exposed parts of her brain were also showing signs of disease, which was a point of surprise for Bartholow as Mary did not show any sign of cognitive damage.
Despite the nature and severity of her wound, it is not clear how long Mary had been receiving treatment for, why she ended up with Bartholow, or why she consented to the experiments he hoped to perform but perform them he did.
‘‘As portions of brain-substance have been lost by injury or by the surgeon’s knife, and as the brain has been deeply penetrated by incisions made for the escape of pus, it was supposed that fine [insulated] needles could be introduced without material injury”, Bartholow wrote.
Bartholow proceeded to carry out several experiments on Mary’s brain over the course of a week where he probed specific regions with these electrified needles. Mary’s experience during these sessions varied from giggling and feeling a tingling sensation to having seizures, convulsing, and crying.
None of the tests had any therapeutic purpose, instead, they sought to answer questions about the human brain that niggled Bartholow. In particular, he wanted to know how the stimulation of certain parts of the brain could reveal how the body was “wired”, for want of a better word.
The idea that the brain may be made up of different centers that controlled different functions, what we would today call the “localization of functions”, was relatively new and many of Bartholow’s contemporaries had started to map out these centers by experimenting with animal subjects. However, no one had yet tested these findings on humans and Bartholow, equipped as he was with the latest electrical medical tools and a hard attitude, was uniquely placed to be the first.
This is not to say that he did not envisage therapeutic benefits in the long run, it’s just that any benefits gleaned from this research would be for the future and not for Mary.
Soon after he started to experiment on her, Mary’s condition deteriorated. She had been reduced to a pale and depressed individual, her lips were blue, and she was constantly nauseous. She could barely walk and experienced some paralysis of her right side. Bartholow was forced to stop the experiment after six days. Not long later, Mary died.
Bartholow went on to produce a characteristically cold assessment of the experiments, which he published three months later. Rather than draw any important conclusions about his findings, he instead presented them descriptively and largely left their interpretation to others to decide. Ultimately, Bartholow stated, “further observations will be needed to decide the important question of the electric excitability of the cerebral hemisphere.”
His report lacked any sense of remorse for what happened to Mary, which generated criticism from other doctors. In fact, members of the medical community were so upset that Bartholow was forced to issue an apology in the British Medical Journal.
“Notwithstanding my sanguine expectations, based on the facts above stated, that small insulated needle-electrodes could be introduced without injury into the cerebral substance, I now know that I was mistaken”, he expressed.
“To repeat such experiments with the knowledge we now have, that injury will be done by them, would be in the highest degree criminal. I can only now express my regret that facts which I hoped would further, in some slight degree, the progress of knowledge were obtained at the expense of some injury to the patient.”
Despite this criticism, Bartholow’s reputation and career remained strong. He was eventually given a prestigious position at the Jefferson Medical College in Philadelphia where he worked until he retired in 1893. He eventually died in 1904, though he was apparently plagued by poor health and mental torment during his final years.
Bartholow’s story is a powerful reminder of how important medical ethics are. However, to many scientists, Bartholow’s sins were forgivable, and he is largely remembered as a pioneer in electrophysiology and the human brain. If he was cruel, his cruelty was the result of ambitious curiosity. Alas, we do wonder what Mary Rafferty would say about that.
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