Who Goes First? The Story of Self-Experimentation in Medicine<i> by Lawrence K. Altman MD (Random House: $22.50; 420 pp.)</i>
On Aug. 27, 1885, a Peruvian medical student named Daniel Carrion had himself inoculated with material from a lesion above the eye of a 14-year old boy. The youngster was suffering from an exotic disease known as verruga peruana , and Carrion hoped to give the ailment to himself, thereby allowing local practitioners to more easily diagnose the disease in its early stages. On Oct. 5, Carrion died, a victim of his own hand. Was he a hero to medicine or simply a naive young man who disgraced the profession?
This, as well as numerous other engaging tales, are contained in “Who Goes First?” a lively and compelling history of one of the oldest and most controversial subjects in medical science: medical self-experimentation--doctors who have used themselves as human guinea pigs in pursuit of medical advancements.
The author, who is a senior medical correspondent for The New York Times, spent three decades researching this book, traveling from the Arctic to the Tropics to interview medical investigators, ranging from young doctors to Nobel Prize winners. The result is an outstanding factual account of one chapter in medical history that will have broad appeal for the general public and the medical community alike.
Before any medical advance can be adopted, it must first be tested on a human. In 1709, Alexander Pope, in his essay on criticism, wrote, “Be not the first by whom the new are tried, nor yet the last to lay the old aside.” “Who Goes First” recounts the often bizarre and dangerous experiments of investigators who chose to ignore Pope’s warning and instead follow the Golden Rule of medical research--experiment first on themselves.
In 15 chapters, Lawrence K. Altman leads us through the discovery of anesthesiology, vaccination, pharmacology, and many related subjects. We are told of the young German intern, Werner Forssmann, who stubbornly pushed a catheter through a vein to his own heart then walked down a flight of stairs to the X-ray department to verify his results. Forssmann’s bravery helped make possible the miracle of open-heart surgery.
Many of us have undergone surgery of some type that necessitates either a general or local anesthetic. However, “Who Goes First?” teaches us that surgery was not always a painless procedure.
For example, the French surgeon, Ambroise Pare, developed a novel approach to painless surgery during the 16th Century: He put a wooden bowl over the head of a patient and pounded a hammer against it to knock him unconscious. Medicine has indeed come a long way in the last 400 years.
The most controversial chapter is entitled “The Myth of Walter Reed.” In 1900, an Army Commission headed by Reed conducted a fascinating series of experiments on human volunteers in Cuba that proved that yellow fever was spread exclusively by mosquito bites and not through clothing or bedding contaminated by victims.
Reed returned to Washington shortly after all Commission members agreed to self-experiment. Reed’s biographers say he was ordered back to Washington by the surgeon general. While he was away, Jesse Lazear and James Carroll, both Commission members, contracted yellow fever through self-experimentation. Lazear’s case was fatal.
It is quite true that Reed did not experiment on himself in Cuba. However, William B. Bean, Reed’s most recent biographer, suggests that Reed was advised or ordered not to experiment on himself. Also, Gen. Albert E. Truby, the commander of the hospital in Cuba, wrote in 1943 that Reed became much perturbed when one of the volunteers changed his mind about receiving a blood injection from a yellow fever victim. Reed announced that he would take the place of the volunteer, and he came to the laboratory the next day determined to take the test. However, a young private, John Andrus, came forward and volunteered in Reed’s stead. Andrus took the injection and developed a severe case of yellow fever.
Medical research generally progresses in logical steps. It begins with laboratory experiments, proceeds to experiments on animals, and when these show promise, further tests on humans are performed. However, it is difficult at best to extrapolate from animals to humans; ultimately, man must face the test.
Experiments with humans always involve risk; the potential for illness, injury, or death may be reduced, but it can never be eliminated. Therefore, the question arises as to why healthy people should be subjected to experimentation. Altman gives us the reason: “Researchers must know what is normal in order to appreciate what is abnormal, and what is normal can only be learned from studies on healthy individuals.”
Medical science really cannot progress without human experimentation. As legislation mandates human experimentation for many medical research projects, the number of substances tested on humans will continue to increase due to society’s demand for cures and preventives for diseases such as AIDS and cancer.
Another pertinent question is how valuable the information is that is derived from self-experimentation. Generally, it is very difficult to interpret results on only one volunteer, although Forssmann’s self-catheterization would certainly be an exception.
Also, who is to be held accountable should something go wrong? In the case of Carrion’s death, his friend and colleague who helped to inoculate him was charged with murder. Only an eloquent plea in defense of medical martyrs by Carrion’s teacher convinced the authorities to drop the charges.
Recently, it was announced that a researcher had injected himself with a potential vaccine for AIDS. Clearly, although “Who Goes First?” is a highly enjoyable account of past experiments, its content remains relevant today.
