Physician, Experiment on Thyself

While the Biblical imperative “Physician, heal thyself” (Luke 4:23) does not call for self-experimentation, there is a certain religious zeal, if you will, that has driven some physicians to do just that. The motivation and propriety of medical self–experimentation can be debated, but the many known examples make for more than a few good stories. Here are just three—the ones where such temerity was rewarded with a Nobel Prize. 

Why Would Anyone…

Why would anyone perform a medical experiment on oneself? For one thing, it avoids delay or possible denial that attends an approval process. It also provides unfettered access to real–time data. And self–experimentation can lead to fame.

But death may attend medical self–experimentation, a grim data point that has the disadvantage of being a one–time event. It can also interfere with data collection, as illustrated in the case of Edwin Katskee. In 1936 he injected himself with a large dose of cocaine, intending to record his experience. His body was discovered the next day, lying next to a wall full of notes, which were indecipherable. (A dramatization is available on Youtube).

Despite the risks, the list is long of those willing to make of themselves “subject number one”. (As an aside, perhaps the first documented case is that of the Father of Experimental Surgery, John Hunter [1728-1793], as reported by Wendy Moore in The Knife Man, covered in the chapter entitled “The Surgeon’s Penis”, of which no more will be said here).

We select for discussion those cases of medical self–experimentation for which one consequence was the award of a Noble Prize in the related area of study—three in all. Two other Nobel Prize winners, Elie Metchnikoff and Rosalyn Yalow, were self-experimenters, but not in the same field as their Prize.

Armed With Defiance

A number of surgical cases are known, the most celebrated of which involved deception and defiance. The scene is Eberswalde Germany, not too far from Berlin, the birthplace of Werner Forsmann. In 1929 he matriculated from the University of Berlin with a medical degree in one hand and a burning ambition in the other. His department chief told him, ’no, you may not come here and perform an experiment on yourself’. But an OR nurse was more amenable to his ambition—she agreed to be the subject of his experiment. 

Forsmann’s burning desire?—to show that it was possible to pass a catheter from one’s arm up into a chamber of the heart. As he strapped the nurse to the table in preparation, it became clear to her that he had intended all along to do the procedure on himself. Once he began, the nurse had then to guide him to the radiology suite, where he used a fluoroscope to guide the catheter a full 60 cm, up and into his right ventricle. This was a death defying stunt—perforation could have been fatal. But his success won over his superiors, and would eventually, in 1956, win over the Committee in Stockholm, which awarded him a share of the  Nobel Prize in Physiology or Medicine.

 Werner Forsmann

Werner Forsmann

 German Commemorative Stamp

German Commemorative Stamp

If you’re wondering what Forsmann did during the war: he was a major in Hitler’s Wehrmacht and spent some time as a guest of the US Army in a POW camp. But his medical career as a urologist, (it was, in fact, a urinary catheter that he first used), was quite honorable, ending in academic awards and professorships. His unbridled curiosity established the field of cardiac catheterization, an essential and life–saving technique of modern medicine. 

Enough to Give You an Ulcer

Barry Marshall and Robin Warren became the dynamic duo (as clinician and pathologist) from Western Australia. It was there, close to home, where they met and collaborated, destined to benefit from serendipity and overcome skepticism. Their discovery would, eventually, change a centuries old paradigm about an age old problem—gastric ulcers. They suspected that a bacterium might cause gastritis and thus ulcers. Working on just twelve months of funding, they recruited the hospital lab techs to culture stomach fluids. One hundred samples were planned. The first thirty showed no sign of H. pylori, the bacterium in question. These cultures were tossed, according to the rule in place for the tech’s usual specimens, routine throat cultures. Sample #31 arrived during a busy time in the lab. It was not tossed out after 48 hours as per routine. On the fourth day, H. pylori presented itself.  H. pylori, it turned out, needed just a little more incubation time to become apparent.

For Marshall and Robin it was off to the races, or so they thought. But the Gastroenterological Society of Australia declined to print their paper. In fact they placed it at the bottom of the pile of all submissions that year, 1983. It was becoming clear to them that the medical establishment regarded their theory as crackpot. To make matters worse, they were having no success in establishing an animal model—piglets were just not showing signs of artificially induced H. pylori–induced gastritis. 

 Marshall and Warren

Marshall and Warren

 Warren and Marshall

Warren and Marshall

That’s when Marshall decided to take matters into his own stomach. He drank a broth of H. pylori, expecting to, maybe, get an ulcer in, maybe, a year or so. By day three he was nauseous and his mother noted his breath began to stink. Endoscopy showed flagrant gastritis (his baseline study had been normal). Tissue examination revealed colonization by the bacteria. His illness progressed until he took antibiotics to great effect—a seminal event in the history of gastroenterology. Their subsequent paper, submitted to the Medical Journal of Australia, was not only accepted but became widely cited. They had gone from scorn to fame, capped by the Nobel Prize in 2005. 

Once Bitten, Might Die

FFirth
The situation with Yellow Fever is more complicated, encompassing three eras of self–experimentation, beginning with the rather repulsive efforts of one Dr. Ffirth, of the faculty of the University of Pennsylvania. His hypothesis was that the 1793 Yellow Fever epidemic that killed 5000 Philadelphians (10% of the city’s population) was not, we say not, due to a contagious disease. His thesis, published in 1804, was supported by the fact that he survived doing this. With fluids acquired from victims, he exposed himself by applying them to self–inflicted cuts, washed his eyeballs with it, drank it and inhaled the fumes of fried vomit. And still, he did not contract Yellow Fever—QED However, it is now supposed that his escape from calamity was due to the fact that his samples were from late stage, I.e., no longer contagious, victims.

Lazear
Almost one hundred years later, the Cuban epidemiologist Carlos Finlay postulated that Yellow Fever was not only contagious, but the vector was a mosquito, the Aedes aegypti species. Field research was commissioned by the American Yellow Fever Board, which sent physicians to Cuba to get to the bottom of things. Of these, the only one with a working knowledge of mosquitos was Jesse Lazear, a researcher out of Johns Hopkins, via Columbia College of Physicians and Surgeons and the Pasteur Institute. 

In 1900 he wrote home that he was on the verge of discovering the cause of Yellow Fever. In his enthusiasm he let a known infected mosquito bite him. He died a few weeks later from the disease. The deliberate nature of his action was obscured until his notebooks were reexamined in 1947. It is said that a fiction was put forth that his death was accidental, so as not to deprive his widow of insurance benefits. His sacrifice is today honored with buildings named for him, and his sacrifice is memorialized in stained glass at the Washington National Cathedral.

 Lazear

Lazear

 Theiler

Theiler

Theiler
The vaccine installment of the Yellow Fever story is complicated. This history is treated in great detail in an Arts and Humanities article in the Yale Journal of Biology and Medicine, and is recommended reading. The synopsis goes like this. At the beginning of the nineteenth century it was suspected that Yellow Fever was caused by a ‘germ’ of some sort. Bacteria–based vaccines proved ineffective and “Yellow Jack”, a name taken from the flag of quarantine ships, continued to terrorize ports on both sides of the Atlantic. The Rockefeller Institute, prompted by the opening of the Panama Canal, in an endemic area, went on the scientific offensive. 

They were tripped up initially by mistakenly attributing Yellow Fever to a Leptospira bacterium (the deadly “Noguchi affair”). Nonetheless, a team led by Walter Reed demonstrated the role of the mosquito. Based on filtration studies,  a virus was suspected. It was eventually isolated from a native survivor, transmitted to monkeys, propagated in tissue culture, and tediously attenuated for use in vaccination. 

Max Theiler played a key role in this research. It is said, by some, that he was the first person to be injected with a new Yellow Fever vaccine. What is known for certain is that his work was rewarded with a Nobel Prize in 1950. (Much earlier, there were advocates for the prize to go to Jesse Lazear. But that was disallowed—the prize is never given posthumously).

The film Yellow Jack, MGM 1938, is amusing, but short on documentary integrity. Missing entirely from the cast of characters is the nurse Clara Maass, an expert in tropical disease. She survived the first voluntary bite of an infectiouis mosquito, but not the second.

 Yellow Jack. MGM 1938.

Yellow Jack. MGM 1938.

 Clara Maass

Clara Maass

 US Postal Commemorative

US Postal Commemorative

Wait, there’s more…

There are numerous self-propelled adventures in medical science, such as inflating one’s rectum with hydrogen, ingesting schistosome worms for international transport, injecting oneself with cancer cells, and even just plain crazy attempts at controlled hanging. 

While most are not as illustrious as our three cases, they are all illustrative of unbridled curiosity and inventiveness. Some are exercises in altruism, others in ambition. For a closer look we point you to some related books (via our Amazon affiliate links) and suggest that you check out the podcast the discussions in ScienceNew ScientistScientific American and the Wall Street Journal. For a compendium of cases, the Wikipedia article is quite thorough. And there are two episodes of interest from the podcast Skeptoid#305 and #593

Here are some books to peruse: Who Goes First?: The Story of Self-Experimentation in Medicine, and Guinea-Pig Doctors: The Drama of Medical Research Through Self-Experimentation.


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