House Officers, Then
I have been reading the Winter 2002 issue of Medicine at
Michigan. My attention was drawn to “One
of those awful policies...” on page 50, part of the
“The
Residency Years, Then and Now” article, which states
that African-Americans were not admitted to the U-M residency
program until 1965. I believe the statement overlooks an exception.
I graduated from the U-M Medical School in 1941. After a year
of internship at University Hospital, I spent four years on
active duty in the U.S. Navy as a medical officer during World
War II. When I returned to Ann Arbor in 1946 to start my residency
in surgery under Fred Coller, I found one of my fellow residents
to be Martin Sutler [M.D. 1941], an African-American. As well
as I can recall, he completed his residency about 1950 and went
to Cleveland to open a surgical practice. I do not know where
he served his internship.
Incidentally, a Medical School classmate of mine, Ruth Moyer
[M.D. 1941, Residency 1943], was the first woman to be accepted
for an orthopedic surgery residency at University Hospital.
I think Dr. Carl Badgley [M.D. 1919] came to feel eventually
that he made a wise decision. He had declared previously that
he would never accept a woman.
Wayne H. Stewart
(M.D. 1941, Residency 1947)
Vero Beach, Florida
________
The Winter
2002 issue of Medicine at Michigan states that
“The first black resident was admitted to the program
in 1965.” This, in fact, is not true.
Charles Thurston, M.D. (Residency 1966) was a black physician
admitted to the U-M Dermatology Department residency program,
directed by Arthur Curtis, M.D., in 1963. At the time Charles
was a captain in the U.S. Air Force. He completed his dermatology
residency and was regarded as one of the program’s best
and well-liked residents. Charles continued his career as a
dermatologist in the Air Force, retiring as a colonel. He then
established a very successful private practice of dermatology
in San Antonio, Texas, from which he recently retired.
Harold (Jerry) Richards
(M.D. 1962, Residency 1966)
La Jolla, California
The Legacy of Udo Wile
I submit the following information about Udo J. Wile, M.D.,
in the interest of presenting a fuller picture of his career
at the University of Michigan Medical School.
Udo J. Wile was appointed professor of dermatology and syphilology
in 1912 and served as chairman of the department until his retirement
in 1947. He remained interested in dermatology and syphilology
until his death in 1982.
Wile was the author of at least 145 publications. He volunteered
and served in both World War I and World War II. He was the
commander of a U.S. Army hospital in Liverpool, England, in
1917-18. During the Second World War he was a commissioned officer
of the U.S. Public Health Service. In that role, he supervised
the creation and monitoring of sixty-two Rapid Treatment Centers
for the care of military patients with sexually transmitted
diseases.
During his tenure as the chair of the Department of Dermatology
and Syphilology, Wile trained over 50 dermatologists, many of
whom went on to important careers as chairs of departments of
dermatology. After 1962, “syphilology” was dropped
from the names of departments, the American Board of Dermatology
and the Archives of Dermatology.
Wile was honored during the Medical School’s sesquicentennial
celebration by being named to the Hall
of Honor at the Towsley Center, which distinguishes the
100 most important medical educators in the history of the School.
However, there is an ethical cloud over the head of Udo Wile.
On September 23, 1913, he reported in the Journal of the
American Medical Association about an experiment carried
out at Pontiac State Hospital for patients with mental diseases.
After consultation with the superintendent of the Hospital,
Wile, utilizing a dental drill to access the brain through the
cranium, extracted brain tissue from living patients with general
paresis and was able to demonstrate the spirochete of syphilis
by the use of a darkfield microscope. This was an important
discovery since at this time some syphilologists believed there
were different strains of spirochetes infecting different parts
of the body.
In 1916, Wile reported in the Journal of Experimental Medicine
about an additional study in which he again took brain tissue
from living general paresis patients at Pontiac State Hospital.
He injected the material into rabbits and produced syphilis
in these animals to prove that only one strain of spirochete
was present and able to pass the infection from general paresis
patients to others.
There was significant negative reaction to the two studies of
Udo Wile, both in the general public and in the scientific community.
The antivivisectionists initiated a campaign which included
newspaper editorials very critical of Wile. At the same time,
the negative reaction in the scientific community was manifested
by letters to the editor of JAMA from such prominent
physicians as William Keen, a Philadelphia surgeon, and Walter
Bradford Cannon of Harvard Medical School. Both physicians criticized
Wile in print and in private letters to him. They were concerned
that Wile’s experiments were giving aid to the antivivisectionists’
campaign to stop all human and animal research. During the period
of controversy, Wile was defended by Victor Vaughan, the dean
of the Medical School. Wile was quoted when asked by a reporter,
“You may quote me as having absolutely no interest in
the matter, whatever people may wish to think regarding my experiment.”
Wile’s experiments violated the code of medical conduct
then in force, the AMA Code of Medical Ethics of 1847, which
was derived from the Hippocratic Oath and had as its basic premise,
primum non nocere; first, do no harm. Wile used defenseless
patients and put them in harm’s way. If he had accidentally
struck an arterial blood vessel while drilling into the heads
of these patients, he could have had to deal with a life threatening
complication — hemorrhage from a major artery. He was
a dermatologist/ syphilologist, not a neurosurgeon. In addition,
while the concept of freely given informed consent had not been
codified in 1916, the Prussian parliament in 1898 took the position
that consent of the subject was essential in all human experimentation.
Is it reasonable, in view of his unethical experiments, even
by 1916 standards, to honor Udo Wile with a plaque and picture
and a memorial lectureship in his name?
Michael J. Franzblau
(M.D. 1952)
San Francisco, California
________
The ethical conduct of research is the critical foundation
of academic medicine and one that we at Michigan believe in
unconditionally. We would, however, like to address some of
the cogent historical issues Dr. Franzblau has raised about
the research conducted by Professor Udo Wile at Michigan in
1916.
Susan Lederer, in her article in the Bulletin of the History
of Medicine (1984; 58:380-387) and in her monograph on the subject
of human experimentation in the decades before World War II
(Subjected to Science, Johns Hopkins Press, 1995), clearly delineates
— rather than condemns — just how complicated it
is to judge past researchers’ conduct using 21st century
medical standards. As she notes: “[the Wile affair] illuminates
the dilemma that they [early 20th century medical scientists]
faced in reconciling their personal views of the ethics of experimenting
on human beings with their commitments to continued medical
progress.” The biggest problems emerging from Udo Wile’s
research on syphilis, using brain tissue extracted from insane,
tertiary syphilitics at the Pontiac General Hospital, was that
he did not obtain informed consent nor did the trephining procedure
help in the diagnosis or treatment of these individuals. Indeed,
Wile’s sole justification was that the information he
might gather could be used to help future patients — especially
by proving that tertiary syphilitics had living treponemes in
their brains and were capable of transmitting syphilis to another,
something that was not fully understood and accepted at the
time.
These experiments remind us, however, that safeguards on human
subjects research were quite different circa 1916 from those
of today. In fact, there existed no institutional review boards,
per se, nor did major medical associations, such as the American
Medical Association, have clear guidelines of what could and
could not be done in the laboratory with either animal or human
subjects. As Lederer notes in her Bulletin of the History of
Medicine article, “human experimentation remained a matter
of institutional policy and individual preference.” This
is hardly a blanket excuse, and a lack of policy led to disasters
like the Tuskegee Syphilis studies and several other experimental
studies no researcher would contemplate today.
As Lederer shows quite elegantly, in 1916 the medical community
was rather divided as to how to respond to the Wile studies
themselves. Leading medical statesmen such as W.W. Keen and
Walter B. Cannon wanted to condemn Wile’s work but also
feared setting back medical research progress by giving ammunition
to the rather vociferous antivivisection lobby that existed
during the early decades of the 20th century. Other scientists
of the day felt Wile was justified in the methods he chose to
employ. Hence, it is critical for early 21st century observers
to remember that by 1916 standards, Wile’s work was objectionable
research to many, but not to all, medical scientists. And as
distasteful as it is to us all today, calling it unethical is
a modern day conclusion, not an historical one.
How, too, should we consider with hindsight the responsibilities
of the editors who published Wile’s work in the Journal
of Experimental Medicine and Journal of the American
Medical Association? Simon Flexner, editor of the Journal
of Experimental Medicine, denied even accepting the paper,
stating he was away in China at the time of its acceptance,
and his assistant editor, Henry James Jr., was somewhat obtuse
in accepting any responsibility as well. The editor of JAMA,
Morris Fishbein, had no formal declaration of contrition but
did publish editorials by Keen and Cannon discussing the rights
and wrongs of human experimentation. To make matters more complex,
Wile’s own dean at Michigan, the eminent Victor Vaughan,
dismissed the affair as one of philosophical differences only
rather than one of the protection of human beings “subjected
to science.” In a letter to W.W. Keen, Vaughan argued:
“To me the only point is a question of an individual’s
ethics, whether or not an operation should be done upon an insane
person incapable of giving consent.”
We get into even murkier water when we consider just how common
it was to conduct experiments well into the 1950s in this country
on individuals who were disabled, insane, mentally retarded,
or convicts. The celebrated Jonas Salk conducted his first field
trial of the inactivated polio vaccine (before the famous 1954-55
field trials conducted by Thomas Francis here at Michigan) on
“crippled” boys living at the Watson Boys Home outside
of Pittsburgh. Similarly, Saul Krugman and others tested their
Hepatitis A vaccine on retarded boys at the Willowbrook Home
during the late 1950s and early 1960s. This is hardly a conclusive
list; we merely bring these famous examples to show how common
the practice was.
What should we do about removing Udo Wile’s name from
our Hall of Honor? In doing so, should we not also remove Victor
Vaughan from the same wall, not to mention from the building
that bears his name, and the medical student historical society
or the two professorships that bear his name? Should we ask
JAMA to retract the cover of the February 16, 2000, issue which
bears Vaughan’s portrait? Wile’s collaborator on
one of the syphilis studies was a young Paul DeKruif, a Michigan
graduate and later a best-selling author. We have at Michigan
a medical student writing award and a professorship named in
DeKruif’s honor — this, too, might need to be revised.
We mention these issues only to highlight the complexity of
knowing where condemnation of Wile’s research should begin
and end.
All of these issues were, in fact, carefully discussed by the
Medical Center Alumni Society’s Committee of Nominations
for the Hall of Honor on March 21, 2002. The committee also
consulted several medical historians, ethicists and the original
publications by Udo Wile during its deliberations.
Although one member of the Committee could not attend the meeting
and abstained in advance, the other four members present voted
unanimously to retain the Udo Wile plaque as part of the Hall
of Honor. Among their reasons included the facts that the standards
of human experimentation in the U.S. during this period were
markedly different from those practiced today and that no subject
was injured during Wile’s studies. More pragmatically,
the Committee noted that Wile was honored for his general contributions
to medicine and, more specifically, for being professor and
chair of Dermatology at Michigan for several decades.
The Nominations Committee’s report was then presented,
the following day, to the Medical Center Alumni Society’s
board of directors. The board voted unanimously to accept the
recommendations of the Nominations Committee to retain the Wile
plaque.
We are deeply indebted to Dr. Franzblau for reminding us of
this chapter of Michigan medical history. Over the past several
months he has inspired thoughtful discussions and lectures on
the ethical conduct of human experimentation for our students,
residents and faculty. He has served as an active and caring
member of our University’s alumni community by reminding
us that the idea of an institution of higher learning is to
tackle tough subjects and shed light on them even if they make
us uncomfortable. Dr. Franzblau’s contribution to this
ongoing dialogue has been invaluable, and we hope he agrees
that we have reached a reasonable conclusion to a carefully
considered problem.
We are proud that our Medical School has taken a national leadership
role in studying the historical and ethical implications of
human experimentation through the activities of its Historical
Center for the Health Sciences, the Bioethics Program, and the
Program in Medicine and Society. Most important, as we enter
the 21st century, we are engaged in a major effort to expand
our Institutional Review Board process so that four review boards
(and more than 60 faculty members) are examining each and every
experimental protocol conducted here at the University of Michigan
in order to uphold the more rigorous – and enlightened
– standards of today.
Allen S. Lichter (M.D. 1972)
Dean of the Medical School
Howard Markel (M.D. 1986), Ph.D.
Director, Historical Center for the Health Sciences
George E. Wantz Professor of the History of Medicine
George Morley (M.D. 1949, Residency 1952)
Chair, MCAS Hall of Honor Committee on Nominations
________
The decision of the MCAS board was communicated to Michael
Franzblau on April 26, regarding which he concludes:
It is my feeling that I have been given ample opportunity to
present my concerns about Dr. Wile to significant members of
the Medical School’s community. While I was disappointed
by the decision reached by the MCAS Committee on Nominations
for the Medical Center Hall of Honor, I had my “day in
court.”
I accept the decision of the Committee and consider the matter
closed.
Your commitment to ethical conduct at the Medical School by
the creation of as many Institutional Review Boards as necessary
to accomplish the ongoing responsibility for research, both
scientific and therapeutic, is to be commended.
My medical class will celebrate 50 years since graduation this
year. I am proud to be an alumnus of the University of Michigan
Medical School, and your treatment of my concerns plays a very
large role in that pride.
Michael J. Franzblau
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