It was while Peter Buxtun was working as a venereal-disease investigator for the Public Health Service in San Francisco in 1966 that he overheard a lunchtime conversation that would not only confound him but ultimately place him among the most important whistleblowers in American history.
A graduate of the University of Oregon and psychiatric medic in the army, Buxtun had taken a job as an investigator/interviewer tracking down the sex partners of those individuals determined to have contracted gonorrhea and syphilis. Returning to the coffee room of the clinic at 33 Hunt St. after lunch one day, he heard a senior officer tell two nurses of a strange story concerning a severely ill man in Alabama who had been taken by his family to a private physician for treatment. The doctor recognized the symptoms as tertiary syphilis and gave the man a shot of penicillin. After the visit, however, local PHS officials came down hard on the physician. They informed him the man was part of a special clinical investigation and should not have been treated.
“I couldn’t believe what I was hearing,” recalled Buxtun. “It ran counter to everything I had learned as a venereal-disease worker. It’s not what our mission was.”
Perplexed that a legitimate clinical trial could preclude treatment to a sick, insane individual, Buxtun followed up with his own investigation and requested whatever material was available on this unusual nontreatment study in Macon County, Alabama. The package Buxtun received was shocking. Though hundreds of men had syphilis—they were told they had “bad blood”—all they were given was aspirin and tonic. Also included in the package were accounts of “roundups,” or the periodic collection and examination of the 400 syphilitic men in the study. PHS doctors were interested in charting the progress of the disease until the study’s final stage, autopsy. Buxtun was stunned by what he read, especially that all the subjects in the exercise were poor black sharecroppers.
Buxtun then went to the public library to look for everything he could on Nazi experimentation during the war, the subsequent trial of German doctors, and the crafting of the Nuremberg Code of ethics whose first principle stated, “The voluntary consent of the human subject is absolutely essential.” His intention of sending his assessment of the Tuskegee Study to his superiors was not met with support by co-workers. People, he was advised, lost their jobs for a lot less.
During the next few years Buxtun did battle with his CDC superiors over the Tuskegee Study—on one occasion he was summoned to Atlanta for a “Look here, young man” lecture—but the study continued unabated. Though repeatedly thwarted, Buxtun, the son of a Jewish Czech father and Catholic Austrian mother, was made of sterner stuff than the few others who had qualms about the study. Even after leaving the PHS for law school, Buxtun brought the issue to the attention of anyone who would listen.
Finally, in 1972, Edith Lederer, a young reporter with the Associated Press, listened with alarm to Buxtun’s story. She requested his documentation and passed it on to her superiors. In June, newspaper headlines across the country would scream “Syphilis Victims in U.S. Study Went Untreated for 40 Years,” and the nation began to re-evaluate its practice of using vulnerable, institutionalized populations as raw material for medical research.
It was just before that searing revelation that I, too, became familiar with the use of the powerless as test subjects. After earning a master’s degree in history from Villanova in 1971 and just 23 years old, I began working in the Philadelphia prison system. That first day was an eye-opener. In addition to the cacophonous screams and belligerent shouts of hundreds of angry inmates wandering about the corridors and cell blocks, was the surprising sight of dozens of grim-faced, Black Muslims (members of the Nation of Islam) marching to the chow hall and the exercise yard under the command of their own religious officials. Even more chilling was the spectacle of scores of wounded prisoners; inmates wrapped in gauze pads, adhesive tape, and surgical dressing.
With many inmates appearing to have survived a violent gang war in the prison yard or some cell-block catastrophe, I couldn’t help but wonder if my decision to launch a literacy program in the Philadelphia Detention Center was not only imprudent but downright dangerous. The next morning, I asked a guard on A Block why so many men required bandages and medical dressing? What had caused such mass carnage? “Oh, that’s nothing,” replied Officer Reaves with a chuckle. “That’s just the perfume experiments for the University of Pennsylvania.”
I’m skeptical by nature, so the answer baffled me. Imagining hundreds of heavily perspiring, foul-smelling prisoners wearing Chanel, Estee Lauder, and Arpege by Lanvin for an Ivy League university fell somewhere between incomprehensible and ridiculous. After replying, “Are you kidding me?” I quickly followed with a series of questions running the gamut from “What types of perfumes?” and “Why the need for bandages?” to “How long do the experiments last?” “Do the inmates volunteer or are they forced to participate?” and “Are there any negative repercussions from the tests?”
The officer patiently answered my questions, but after 20 minutes grew irritated and sternly informed me, “Look, Mr. Hornblum, you and I wouldn’t do it. No tellin’ what these doctors are injecting and rubbing on these guys. But these inmates are crazy. They’re desperate, they’ll do anything to make some money. This is the only way they can do it in jail, by becoming a guinea pig.”
I was admittedly preoccupied with the unexpected discovery that an urban jail had been transformed into a clinical research center, but my attempt to learn more was hindered by a culture of acceptance reinforced by strict paramilitary discipline. The inmate test subjects were willing to answer my questions but had no idea what they were testing or being exposed to. Institutional staff were tight-lipped. As Officer Reaves had warned me, “You’re new here, Mr. Hornblum, not the tests. These experiments been goin’ on for 20 years. You just better get used to it and stop askin’ questions, or you’ll be outta here.”
The creation of an entrepreneurially-oriented dermatologist named Albert Kligman, the prison system’s human research mill was well-entrenched and not open for discussion. Everyone who worked at the prison—from administrators and correctional officers to social workers and medical staff—seemed comfortable with the testing program and with its use of human beings as research animals. Even the better-educated employees of the institution, the social workers, occasionally counseled inmates to get on the tests if they were in need of money. I, however, remained puzzled by everyone’s unquestioning acceptance of a vast human-research endeavor that depended on imprisoned minorities for its success.
Why, I repeatedly asked myself and others, was everyone who worked in the jail so accepting of several thousand incarcerated individuals over many years—the vast majority of them unschooled African-Americans—being used as raw material for research by a few men in white lab coats with M.D. or Ph.D. after their names? The answer repeatedly given was, don’t rock the boat—the fewer questions, the better. Even my superior at the Board of Education instructed me: “Allen, don’t bring up these inmate experiments anymore. The prison system will not only throw you out but the educational program as well.”
Though I reluctantly did as ordered, daily exposure to mass testing did not temper my skepticism or curiosity. It was clear more than perfumes were being studied—rumors had all sorts of drugs, chemicals, and procedures being investigated, including tests orchestrated by the U.S. Army. Inmate complaints of injury were widespread, physical trauma was obvious, and some participating in military psychotropic-drug studies walked around the jail like zombies. But opposition to the research was nonexistent.
In early 1974, Kligman’s research program vanished; escorted out the door in the wake of the tsunami of bad publicity caused by Buxtun’s Tuskegee Study revelations. Medical research programs across the nation using institutionalized populations were now considered not only unethical but immoral and dangerous. Research programs were shuttered.
It would be two decades later, and while working in the Philadelphia Sheriff’s Office, that I decided to revisit the prison-research issue. Haunted by the memory of mass experimentation on a captive population, and dismayed the intervening years had not witnessed a journalist, historian, or medical ethicist tackle what I suspected was a penal/medical hustle of grand proportions, I began tracking down former inmates, doctors, and documents. The five-year-long quest resulted in the 1998 publication of my book Acres of Skin and a clearer understanding of how the prison system of a major metropolis had evolved into a large, long-term human-research facility.
Dr. Albert M. Kligman began his “research” in the early 1950s to foster the training of young dermatology residents. But he quickly found the human flotsam and jetsam incarcerated in the city’s prisons too valuable a commodity to go unused. “I felt like a farmer seeing a fertile field for the first time,” Kligman readily admitted after observing the imprisoned population.
Within a short time, Kligman, with the support of the dermatology department of the University of Pennsylvania School of Medicine, had moved from rudimentary studies to more sophisticated (and dangerous) investigations such as a 1958 study (that) inoculated scores of prisoners with such ectodermotropic viruses as wart virus, vaccinia, herpes simplex, and herpes zoster. The subjects of these experiments were healthy “colored” male volunteers, 20 to 45 years of age who volunteered to be inoculated several times. In the wart virus section of the study, 47 inoculations were performed in seven volunteers in different skin areas (forearm, palm, face, scalp, and penis). All of the recipients developed at least one lesion, some of them two lesions at different locations.
In addition to the greater variety of experiments was a heightened threat of injury. For example, Kligman developed an interest in nuclear medicine in the mid-1960s and sought the use of radioactive isotopes for his clinical investigations. He had no personal knowledge of or training with such dangerous material, and he needed such a person to acquire it from the government. His application with the Atomic Energy Commission (AEC) for the license and use of radioactive material was signed by Dr. Benjamin Calesnick, a professor of human pharmacology at Hahnemann Medical College.
When I confronted him about his involvement with Kligman’s prison research, Calesnick grew indignant and insisted: “I did not operate radioactive material testing at Holmesburg. The whole thing was a fraud.” Calesnick would go on to express his frustration and outrage that he had been drawn into Kligman’s deceptive gambit with the biting comment that Kligman had a “reputation as an operator.” He knew “how to make money out of medicine.” It turned out that Dr. Calesnick, the authorized and trained nuclear-medicine specialist, never set foot in a Philadelphia prison and was totally in the dark as to what Kligman was doing with the isotopes. The AEC was never sure what Kligman was up to, either. As for the test subjects, they were never informed they were being injected with radioactive material.
Similarly, in 1964 when Dow Chemical came calling with a protocol that exposed inmates to dioxin (a highly toxic and dangerous carcinogenic substance), Kligman’s only concern was his fee. The application of dioxin on the faces and backs of dozens of prisoners—the vast majority African-American—may remain the only instance of the scientific community purposefully applying the substance on humans. When I asked Verald Keith Rowe, the Dow coordinator of the project, if he had any concerns about African-Americans being the bulk of the test population (of the first 56 inmates to be exposed to dioxin, 47 were black), he replied, “I don’t have too much of a problem with Kligman’s operation in that regard.” The inmates who were receiving a dollar a day for renting out a piece of their skin were never told the name of the substance or its cancer-causing potential. Kligman received $10,000 for his services.
As the years passed, Kligman’s large stable of test subjects became well known to those in the field of human experimentation. By the mid-1960s the U.S. Army Chemical Corps had also entered the Philadelphia Prison System in search of psychoactive substances that would create the Manchurian candidate as well as neutralize an enemy on the battlefield. Military psychopharmacologists from Edgewood Arsenal, Maryland, routinely traveled to Philadelphia in hopes of discovering new psychological weaponry. The Army installed three large trailers with padded cells between two cell blocks and began nearly 10 years of mind-control experiments. Though the inmates were paid relatively well by prison standards ($2 to $3 a day), many were so incapacitated by the experimental agents (hefty doses of drugs like atropine, scopolamine, and belladonoids) that they no longer remembered their names or where they were, and were made to wear name tags so that guards and others could identify them.
Despite the prison system’s willingness to become a secret military testing site, Army physicians were not enthralled with Kligman’s operation. “I was not pleased with the quality of work there,” admitted Dr. James S. Ketchum. “I was not satisfied with the way he was using our initial subjects, and I expressed myself rather assertively.” Army Lt. Col. M.G. Bottiglieri was even more critical, blasting Kligman’s reports as “pure gibberish … absolutely useless … nothing but a list of clichés seemingly pasted together without consideration of coherence in an attempt to provide a facade of competence and ability.” But the Philly skin doctor had what they wanted: test subjects. And so the relationship continued; even the CIA came calling for its research pursuits.
The upshot was the creation of an unusual cottage industry run by Kligman under the auspices of the University of Pennsylvania, the U.S. government, and an array of pharmaceutical companies, a huge Kmart of human-research opportunities for everything from deodorants, detergents, and athlete’s foot medications to phase-one drug tests, cancer studies for tobacco companies, and skin-hardening experiments for the military. Though the phenomenon was not unique—at least half the state prison systems during the 1960s hosted medical research—none rivaled the city of Philadelphia for the number of protocols, inmates involved, and years of operation. For over a quarter-century, the prison system of the nation’s third-largest city became an experimentation factory of unraveled proportions, and no one said a word.
Allen M. Hornblum is the author of eight books, including Acres of Skin, Sentenced to Science, and Against Their Will (with Judy Newman and Greg Dober) concerning the history of using vulnerable populations as subjects for medical research. His latest book, The Klondike Bake-Oven Deaths, will be published in February 2021.