Abstract
Existing scholarship on the sulfonamide experiments on inmates of Nazi concentration camps in 1942 maintains that the experiments were not only ethically and legally completely reprehensible and unacceptable but also bad science in the sense that they investigated questions that had already been resolved by valid medical research. On the basis of contemporary publications, this chapter argues that the value of sulfonamides in the treatment of wound infections, in particular gas gangrene infections, had not yet been established, and that the questions pursued by the experiments had not been resolved. It also argues that in terms of research design and methodological principles, the experiments adhered directly to the rationality of contemporary clinical trials and animal experiments. However, for the step from the animal to the human experiment, the experimental “objects” were considered “human” only with regard to their bodies, but not their individuality and subjectivity. Thus, the experiments demonstrate coherent methodological and scientific rationality combined with a complete disregard of the humanity and suffering of the research subjects. In a concluding section, the chapter highlights some implications of an adequate historical reconstruction of medical research on humans, particularly the importance of a combined focus on scientific rationality as well as on explicit or implicit hierarchies of value. The article also points out the potential impact of a revised image of the sulfonamide experiments on present-day debates on the ethics of medical research.
This chapter is a synthesis of two previously published German-language articles by the author: Die Sulfonamidexperimente in nationalsozialistischen Konzentrationslagern. Eine kritische Neubewertung der epistemologischen und ethischen Dimension, Medizinhistorisches Journal, 44 (2009) and Fortschritt ohne Rücksicht. Menschen als Versuchskaninchen bei den Sulfonamid-Experimenten im Konzentrationslager Ravensbrück. In Eschebach, I., Ley, A. (Eds.). Geschlecht und “Rasse” in der NS-Medizin (pp. 101–114), 2012.
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Notes
- 1.
- 2.
Compare, for instance, the research at the Dachau camp in the context of aviation medicine by Roth (2001). On the eugenically motivated research of Josef Mengele in the context of human genetics, see Massin (2003). On genetic research in the context of psychiatry, see Roelcke et al. (1994) and Roelcke (2000). For diverse examples and aspects of bacteriological research, see Weindling (2000) and various case histories in Eckart (2006).
- 3.
So reads the authors’ final assessment in the most detailed reconstruction and analysis of these experiments available until recently (Ebbinghaus and Roth 2001, pp. 213 and 214). Similar assessments may be found in Silver (Silver 2011); Nadav (2009, p. 123); Cohen (1990); Strebel (2003); Hahn (2008, p. 459). At the Web site for an exhibition on human experiments in concentration camps, “Gewissenhaft – Gewissenlos” [“Conscientious – Unconscionable”] (the Institute for the History of Medicine at the University of Erlangen, n.d.), there is a more differentiated, but not explicitly critical assessment compared to that by Ebbinghaus and Roth. Paul Weindling (2004, pp. 11–15) not only described the context of the experiments but also sketched their practice; yet the scientific rationality for the experiments is not addressed directly.
- 4.
They do this although the authors, in an introductory depiction of the broader context of military surgery, explicitly emphasize how the rapidly changing trench warfare, lack of essential equipment, etc., made fully inadequate working conditions prevalent throughout most of the front, necessitating continuous improvisation. At best, the courses of disease observed under such conditions could be partly documented, but the conditions precluded the performance of planned studies compliant with the methodological standards valid since the mid-1930s (see more detailed discussion below).
- 5.
“[…] this advice was based not on new evidence, of which there was none, but ‘solely upon the current trend of opinion of civilian surgeons, among whom a wave of enthusiasm for this procedure had begun to develop’” (Lesch 2007, p. 215). Lesch, however, does not broach the subject of sulfonamide experiments in German concentration camps.
- 6.
After the assassination attempt, Heydrich died in the beginning of June 1942 as a consequence of extensive infection to the wounds. He had not been treated surgically or with the newest available sulfonamide drugs. His death led to discussions about the appropriate therapy among the highest leadership of the Nazi state. These details have been known since the documentation of the Nuremberg Doctors’ Trial by Alexander Mitscherlich and Fred Mielke (1949/1978). For more recent references, see Ebbinghaus and Roth (2001); Weindling (2004, pp. 11–15); and Hahn (2008, pp. 458–462).
- 7.
If not otherwise noted, the reconstruction of the experimental practice follows Ebbinghaus and Roth (2001), especially pp. 196–211; it is quite detailed to enable an understanding of the underlying rationality.
- 8.
Paul Weindling (2004) has documented the role that the victims had in the emergence of the Nuremberg Medical Trial and the formation of the Nuremberg Code. He also referred to the medical consequences of the experiments and the problematic policy of recompensation of the German state toward the victims (pp. 11–20, 336–338, and passim).
- 9.
According to the postwar statement of Karl Gebhardt, the specific sulfa variants were Katoxyn and Marfanil: see Mitscherlich and Mielke (1949/1978).
- 10.
The historians Ebbinghaus and Roth (2001, p. 206) trace this back not only to the catastrophic general conditions in follow-up care but also to the fact that all probands were treated with dosages too low and for an insufficient period of time. However, they do not refer to the exact dosages applied, nor do they refer to “standard” dosages, and no sources are given for their interpretation.
- 11.
On Martini and his methodology of clinical trials, see Stoll et al. (2005).
- 12.
In 1938 the first in vitro experiments on clostridium welchii, the infectious agent for gas gangrene, were described (Spray 1938).
- 13.
The order of the experiments can be reconstructed from the order of the three publications (titled „Mitteilungen“II-IV). In addition, the exact time of the laboratory work is directly addressed in the texts (Schreus and Peltzer 1941, p. 531; Schreus and Schümmer 1941, p. 705; Schreus et al. 1941, p. 1233). Ebbinghaus and Roth claim that the last experimental series was the first (2001, p. 185).
- 14.
Domagk summarized mostly the positive case reports, with reference to the concrete clinical conditions; he did not recount to the same extent the existing skeptical or critical reports.
- 15.
Domagk himself undertook further investigations on the effects of sulfa drugs in gas gangrene infections in the animal model in 1942. Together with the animal experiments of Schreus, this is an indicator that a number of questions on the exact indications, application forms, dosages, and side effects of the various sulfa preparations were apparently not completely clarified (see Domagk 1943, as quoted in Lesch 2007, pp. 96–97).
- 16.
With this, Kirschner urged for a prospective study design with defined criteria of inclusion for the research subjects, the constitution of control groups, randomization, as well as statistically significant sizes of proband groups and methods of statistical analysis.
- 17.
This refers in fact only to the issues related to the efficiency of sulfa drugs in addition to conventional surgical therapy in Dachau and Ravensbrück, not for the experiments using homeopathic treatment in Dachau. For the sulfonamide experiments in Sachsenhausen, the scarcity of available sources does not allow an adequate historical reconstruction of the exact methods applied and the results.
- 18.
The rationality of the medical researchers is already hinted at in Weindling (2004, p. 12).
- 19.
The results were reported by Gebhardt and his medical assistant Fritz Fischer at Arbeitstagung Ost der Beratenden Fachärzte [Working Conference East of the Consulting Physicians to the Wehrmacht] (Gebhardt and Fischer 1943); see also the statement by Fischer during the Nuremberg Medical Trial, documented in Mitscherlich and Mielke (1949/1978); Ebbinghaus and Roth (2001, note 127).
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Roelcke, V. (2014). Sulfonamide Experiments on Prisoners in Nazi Concentration Camps: Coherent Scientific Rationality Combined with Complete Disregard of Humanity. In: Rubenfeld, S., Benedict, S. (eds) Human Subjects Research after the Holocaust. Springer, Cham. https://doi.org/10.1007/978-3-319-05702-6_5
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