Roberts Bartholow was definitely ambitious.
After earning his degree in medicine in 1852, he served as an army physician until 1864 when he took on a position as a professor at the medical college in Cincinnati, Ohio. In addition to teaching and treating charity patients at the Good Samaritan Hospital, he also developed a fascination with the vivisection research being done in Europe. Scottish neurologist, David Ferrier, had been publishing research into the use of direct electrical stimulation in mapping motor cortex functioning as well as triggering epileptic-like seizures in his animal subjects. Inspired by Ferrier's research, Bartholow chose to go even further.
At the time that Bartholow began planning his radical experiment, there was little consensus concerning the ethical use of human subjects in medical experimentation. Although the Hippocratic Oath emphasized the medical requirement that physicians "do no harm", the prospect of using Ferrier's findings to learn more about the human brain was irresistible to Bartholow and his colleagues. It was in 1874, when Mary Rafferty was admitted to the hospital...
There is little information about her early life aside from the permanent scarring that she had received from falling into an open fire as a child. Later described as "feeble minded", Mary Rafferty was a 30-year old domestic servant with an infected ulcer in her scalp that proved to be cancerous. By all accounts, Mary was "cheerful in manner" and eager to please the doctors who had taken an interest in her case. Since she was terminally ill and had no family connections, using her for Bartholow's medical experiments seemed to make perfect sense. While Bartholow would later insist that Mary had given her full informed consent, the fact that she was also (as he described her) "feeble minded" raises the excellent point that she didn't know what would be involved.
The first procedure involved inserting needle electrodes of differing length directly into Mary's brain. The cancerous ulcer had exposed part of her scalp already and there was actually little pain at first. The electrodes were connected to a battery to administer small electric shocks to parts of the brain. As Bartholow would later report, "When the needle entered the brain substance, she complained of acute pain in the neck. In order to develop more decided reactions, the strength of the current was increased by drawing out the wooden cylinder one inch. When communication was made with the needles, her countenance exhibited great distress, and she began to cry." Mary's arms began to spasm and she went into convulsions followed by a twenty-minute coma.
Bartholow was enthused to be able to report that he had induced the same type of seizure in a human that Ferrier had achieved in animals. Whatever misgivings that his fellow doctors might have had were dismissed and the procedures continued. Over the course of Bartholow's experimenting, Mary developed increasing motor problems including numbness, paralysis, and motor weakness. Following the final session, Mary became incoherent and slipped into a coma after a convulsive seizure. She died a short time later.
It was Bartholow who conducted the autopsy on Mary (no coroner was required). Although he was quick to blame her death on the cancer, he acknowledged that his experiment had led to "intense vascular congestion" along the tracks of the needles that he had inserted into her brain. Still, his experiment was considered to be enough of a success for Bartholow to publish his research results that same year. In describing his results, he freely admitted that his experimentation had injured his patient and that repeating what he had done "would be in the highest degree criminal."
If Bartholow hoped that being candid would protect him from criticism, he was sadly mistaken. In a scathing letter to the London Medical Record, David Ferrier himself denounced the experiment and pointed out that the "depth of penetration of the needles" and the "inflammatory changes" that they produced clearly accounted for the "epileptic convulsions and ultimate paralysis" in the patient. Although Bartholow defended himself by maintaining that Mary Rafferty was "hopelessly diseased" and gave full informed consent, a declaration was later made at a meeting of the American Medical Association that denounced the experiment as "incompatible with the spirit of our profession and our feelings of humanity".
Despite the condemnation, Bartholow's medical career was hardly affected. Leaving Cincinnati in 1879, he moved on the Jefferson Medical College in Philadelphia. He eventually became head of the department and Professor Emeritus until his death in 1904. Bartolow's obituary and various online biographical entries list many of his professional accomplishments as well as the important medical books that he wrote. There is no mention of the Rafferty experiment.
Despite the controversy over the Rafferty experiment and other horrendous abuses, it was only in 1946 that the principle of informed consent in human medical experimentation was formally adopted by the AMA. Following a report by an official AMA observer at the Nuremberg Doctor's trial, the AMA House of Delegates adopted a series of principles to protect human medical subjects (these principles were also enshrined into the Nuremberg code in 1947 and the Declaration of Helsinki in 1964). As a result of these initiatives, all medical and social science research proposals are expected to be evaluated by ethics committees to ensure compliance with modern research standards. While the ethical guidelines have generated new problems for researchers (including the use of deception in psychological research and determining competency to give consent), they remain in place to provide fundamental protection for research subjects.
Mary Rafferty would approve.