Roberts Bartholow Stimulates the Human Brain
Science or Human Experimentation Abuse?
In his Introduction to the Study of Human Experimentation (1865), the French physiologist Claude Bernard advised scientists never to “perform an experiment which might be harmful to the patient even though highly advantageous to science or the health of others.” Physicians need to conduct research on patients to improve the human condition, but sometimes abuses occur for reasons that have little to do with science or the patient's welfare. Although safeguards exist today to protect human subjects, few existed in the 19th century. A case in point involves Mary Rafferty and Dr. Roberts Bartholow.
Roberts Bartholow (1831–1904)
Roberts Bartholow was born in Maryland in 1831. He attended Calvert College and received a Master of Arts degree before choosing to study medicine at the University of Maryland. Bartholow was admitted to medical practice in 1852 and became a U.S. Army surgeon in 1856. He served the Army of the Potomac during the Civil War, until resigning his commission in 1864.
The Medical College of Ohio soon offered him a faculty position, so Dr. Bartholow moved his family to Cincinnati that same year. By 1874, he had become Professor of Theory and Practice of Medicine. He also joined the staff of Good Samaritan Hospital in Cincinnati, where he first met Mary Rafferty.
Human Experimentation Evolved From the Germ Theory of Disease
Experimentation on humans evolved as a byproduct of the germ theory of disease, as set forth by Louis Pasteur and Robert Koch. According to this theory, scientists needed to prove that a microbe did or did not cause a specific illness. As many diseases could not be replicated in animals, research on humans was necessary.
During the 19th century, the process of informed consent was not formalized. Indeed, physicians could simply ask patients to participate in an experiment as an act of good will. Physicians were not obligated to provide detailed information about the exact nature of the experiment unless the physician felt that the research did not have a therapeutic benefit or would cause great pain to the patient. As benefits and pain thresholds are largely subjective, there is reason to doubt how much a patient ever understood about a proposed experiment.
Mary Rafferty Undergoes Electrical Stimulation of the Brain
On January 26, 1874, a feeble-minded Irish servant girl named Mary Rafferty entered Good Samaritan Hospital with an ulcerated tumor on her head. As the attending physician, Dr. Bartholow attempted treatment for about one month, but determined that the tumor was cancerous and her situation hopeless.
Rather than making the patient comfortable in her final days, Dr. Bartholow decided to seize the opportunity and experiment on the exposed portion of her brain. At that time, electric shock therapy had been applied in dogs to find the cause of epilepsy, but never in humans.
Over a series of several days, Dr. Bartholow (1874a) inserted electrode needles in different parts of Rafferty's exposed brain tissue and then applied electric current. He meticulously noted how the convulsions produced on one side of her brain led to motor activity on the opposite side of her body. As Rafferty did not seem to suffer pain from low intensity current, Dr. Bartholow increased the electrical intensity and noted how “her eyes became fixed, with pupils widely dilated; lips were blue, and she frothed at the mouth” before entering a coma that lasted 20 minutes.
What Caused Mary Rafferty's Death?
Mary Rafferty died five days later, and Dr. Bartholow listed the cause of death as due to cancer. During the autopsy, Bartholow noted the presence of brain lesions caused by his electrode needles, which he acknowledged may have contributed “mischief” to Rafferty’s condition. Nevertheless, Dr. Bartholow still maintained the cause of death was due to “epitheliomatous ulceration of the sinus.”
The American Medical Association condemned the experiment, as did The British Medical Journal. Dr. Bartholow (1874b) always insisted that Rafferty had “consented to have the experiments made.” Stung by the criticism, Dr. Bartholow expressed mild regret that “the progress of knowledge” should have been “obtained at the expense of some injury to the patient.”
Dr. Bartholow was never punished for his actions and advanced steadily in his professional career. In 1875, he was one of the founding members of the American Neurological Association, and became president in 1881. During his lifetime he published several textbooks, including Medical Electricity: A Practical Treatise on the Applications of Electricity to Medicine and Surgery in 1887, which described electrical stimulation in some detail without mentioning Mary Rafferty by name. At the time of his death in 1904, Dr. Bartholow was Professor Emeritus at Jefferson Medical College in Ohio.
Human Research Abuse, or Science?
By any moral standard, Dr. Bartholow's actions were unconscionable. Mary Rafferty was weakened by her cancerous ulcer, feeble-minded, and unlikely to have understood enough to have consented to vivisection.
Nevertheless, Dr. Bartholow continues to receive accolades. His 1874 experiment is identified as one of the “Milestones in Neuroscience Research." On February 16, 2009, the University of Maryland School of Medicine acknowledged the achievement of “graduate Roberts Bartholow” in electrical stimulation of the brain. In April 2009, the Winkler Center in Ohio sponsored an exhibit entitled the “History of Neurosurgery in Cincinnati,” which proudly featured Bartholow's experiment.
Mary Rafferty is never mentioned by name in any of these accolades, while criticism of Dr. Bartholow remains muted. Thus, even in bioethics, physicians sometimes need to be reminded of the wise advice given by Claude Bernard nearly 150 years ago.
References
Bartholow R. 1874a. Experimental investigations into the functions of the human brain. Am J Med Sci. 67:305–313.
Bartholow R. 1874b. Experiments on the functions of the human brain. The British Medical Journal. May 30:727.
Bartholow R. 1887. Medical Electricity: A Practical Treatise on the Applications of Electricity to Medicine and Surgery. 3rd edition. Philadelphia: Lea Brothers & Co.
Roberts Bartholow
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