Patient H.M. (11 page)

C
LINICAL
N
OTES

August 9, 1944: Mrs. Scoville continues in Group I activities. She does, however, seem a little superficial emotionally and although she apparently has a little insight, shows that she does not have a fully true understanding. She realizes she should not take on her family duties as yet or the care of her children; that she should have a period of adjustment outside before returning to her home. She wants to go on a vacation up in the Adirondacks with her folks. It does not seem the right place at this time but the family is very insistent that she have this opportunity to see what she can do under the conditions. The mountain resort is known as Keene Valley.

S
unset Hill. That's what we call it. The old house in Keene Valley, New York, about twenty miles southeast of Lake Placid, is still in our family, though its ownership has divided and subdivided as the property trickled down through the generations. Growing up, I spent several weeks there every summer, and now my daughter and I do the same. In most of my memories of my grandmother, she's there, at that house. Like all seven of her grandchildren, I called her Bambam, because that was how my older brother mangled the word
grandma
when he was a toddler, and the nickname stuck. Often, in these memories, Bambam is sitting on the front porch, reading or just looking out over the hill and the mountains beyond it. She can see Spread Eagle, Noonmark, Cascade, and Porter, left to right. On a clear day she can see all the way to Mount Marcy, which at 5,343 feet is the tallest mountain in New York State. Marcy is a dwarf by Himalayan or Andean standards, but the Adirondacks were once just as imposing. Eons of glaciers and oceans of rain have ground them down, worn them away to stumps. Everest is simply younger.

There used to be a Ping-Pong table on that porch, and when I was a kid my grandmother and I would play. Summer by summer it became harder for her to see the ball. She could beat me at first and then she could hold her own and then I could beat her. Eventually, when I was maybe thirteen, she tried and tried and couldn't return a single serve. We stopped halfway through. “I guess I just can't do this anymore,” she said.

During her final decade she didn't go out on the porch as much. She'd stay in the living room, lying on her back on the couch. A piano she used to sometimes play went slowly out of tune in the corner of the room, since no one else in the family had picked up the instrument. She'd listen to books on tape. Mysteries, mostly. She liked Agatha Christie. Sometimes I'd read
The New York Times
to her, and she'd correct my pronunciation.
Coll-eee-gial,
not
coll-eh-gial;
Mue-nick,
not
Mue-nitch.
And then it became too difficult for her to follow the story lines of the books or the articles, so she'd just listen to classical music. Bach or Mozart or Chopin. It became harder and harder to tell if she was awake.

She died when she was 101 years old. Of course she was diminished. Time happens. She was not the woman I once knew, and there is nothing strange or unusual about that.

The question I have is whether the woman I once knew was anything like the woman she really was.

A few days after my grandmother clambered onto the hood of a neighbor's car and placed a noose around her neck, my grandfather wrote a letter to his parents explaining the situation. He asked them to keep the matter quiet, to not tell his wife's family. He also expressed his disbelief.

“Her breakdown came totally unexpectedly for me and I cannot yet realize it or accept it. I love her so—more than anyone in the world—which makes me believe that I can coax her back to us.” Later he describes one of the most puzzling aspects of her breakdown. “She is,” he wrote, “the most outgoing person I have ever known—entirely the opposite of schizophrenia.” He had underlined the word
outgoing
with two fierce strokes of his pen.

I found that letter recently, and the line shocked me. My grandmother was one of the most withdrawn people I've ever met. Whatever the opposite of outgoing is, that's what she was. She spoke when spoken to. If you engaged her in a conversation she was articulate and intelligent, and her memory, at least when she was younger, was sharp. But she was passive. She could sit quietly for hours in a crowded room, never asking a single question or initiating a conversation.

That was the woman I knew. That was the woman my sisters and brother knew. That was the woman my mother and her brothers knew.

My grandfather's letter indicated she had once been different.

After reading it, I thought back to the old stories I'd heard about her youth and realized that there had always been a disconnect between those stories and her later self. This was a woman who'd partied with raucous gun-toting flapper friends drinking bathtub gin in the 1920s, who'd headed off to live in Vienna on her own after college, who'd dated and then ditched the younger brother of Katharine Hepburn. In old pictures in family albums, she's often out on some adventure, horseback riding on a friend's ranch out West, rock climbing in the Adirondacks, skiing in New Mexico. It's always hard to imagine old men or women as they were when they were young, but in my grandmother's case it was impossible to connect the woman I knew with the woman in those stories and pictures.

When I found that letter, I didn't know exactly how many courses of electric shock my grandmother had received. I still don't know. I don't know how often they locked her in that copper coffin and cooked her to 105 degrees, or how many times they strapped her into a tub full of cold water. I don't know whether they ever injected her with insulin and sent her into an artificial diabetic coma or knocked her out with a dose of primal-terror-inducing Metrazol. The records I have from her four-month-long residence at the asylum are incomplete. There are missing pages, monthlong holes in her history. Also, those documents deal only with her first stay at the asylum. She was reinstitutionalized several times, at the Institute of Living and elsewhere, and the records of what happened to her during those subsequent stays have been lost or destroyed.

C
LINICAL
N
OTES

August 15, 1944: Mrs. Scoville was this morning discharged to the custody of her mother Mrs. Learned. They were to go immediately today to Keene Valley in the Adirondack Mountains, she would remain with members of the family for some time. The family was quite insistent that they go now rather than later, or that any other different arrangements be made now. They realize that she, perhaps, was not entirely well yet but was anxious to give her this opportunity; agreed that she should not return to her husband and family for some months until she was completely able to handle herself emotionally or until she had adjusted well. Mrs. Scoville was quite pleased to be leaving the Institute at this time.

A few months after that summer at Sunset Hill, my grandmother moved back in with my grandfather and their children at their temporary residence in Hopkinton, Massachusetts. My mother was six years old. In humans, long-term memories begin to stick sometime around that age. Prior to that, give or take a few years, we all suffer from what memory researchers describe as “infantile amnesia.” The causes of that amnesia are still in debate: Some attribute it to the physical immaturity of young brains, while others argue that the language faculties of infants are simply too undeveloped and that we require words to remember events. In any case, some of my mother's earliest memories are from that house in Hopkinton. She remembers my grandmother spending hours in the backyard, silently tending to a victory garden, and she remembers that when the war ended later that year the community set fire to a derelict house in celebration. Everyone in town gathered to watch the old home burn.

T
wo weeks after the liberation of the Dachau concentration camp, three men sat in the ruins discussing atrocities. Two of the men were American soldiers—an interrogator and an interpreter—and the other was a liberated prisoner, an Austrian patent lawyer named Anton Pacholegg, who'd earned the wrath of the Nazi regime by “having dealings with the Jewish people.” It was May 13, 1945. Pacholegg was shipped to Dachau at the end of 1942 and had been there ever since. At first, his duties at the camp were rudimentary: He swept the alleyways, helped pull a street roller, and worked in the gravel pit. In 1944, however, his professional background caught the attention of the camp administrators, and he was transferred to an office in a building known as the First Experimental Station of the Luftwaffe. During his tenure there, Pacholegg told the Americans, the station changed its name a couple of times, first being shortened to just Experimental Station and then, in March 1945, receiving its final name: Experimental Station: Experimenting on Living Humans for the Benefit of Mankind. Pacholegg's job at the station was to compile reports on the experiments conducted there.

The experiments were designed to provide information useful to the German war effort. For example, German aviators often had to eject from high altitudes, and when they did, the low-pressure environment could wreak havoc on their bodies, leading to ruptured lungs, burst blood vessels, and various other side effects that came with having all the oxygen in their bodies suddenly expand to many times its normal volume. Since the dawn of aviation, when it was observed that balloonists who ascended past a certain height found themselves in acute physical distress, scientists had conducted experiments to understand high-altitude physiology. That research often involved placing rats and other small mammals into pressure chambers and seeing what happened when the pressure was decreased, simulating high-altitude environments. Still, it was unclear how useful animal experimentation was to understanding the unique physiologies of human beings. At Dachau, as Pacholegg would explain there in the ruins of the camp, the Nazis devised a strategy to forgo animal experimentation altogether.

The American soldiers probed deeper, pushing Pacholegg for more details, and he went on to describe a number of the other experiments conducted at the station. To test treatments for shrapnel injuries and other common frontline wounds, camp personnel would lesion the limbs of prisoners and fill them with bits of metal and wood. Sometimes they waited until gangrene had set in, and sometimes they accelerated the process by injecting them with gangrenous tissue samples. Typhus was another chronic problem in the battlefield, so hundreds of prisoners were infected with it and then administered a variety of unproven vaccines. Similar experiments were conducted related to the treatment of malaria, and tens of thousands of malarial mosquitoes were shipped to Dachau for use on the prisoners. During other experiments, prisoners were shot in the thigh with bullets coated with various poisons, and precise recordings were taken of the time that lapsed between penetration and death.

Then there were the so-called freezing experiments. Throughout the war, the German Luftwaffe lost numerous aircraft over the North Atlantic. Many of the aircrews successfully parachuted from their planes before impact, only to freeze to death in the cold ocean waters. Some were pulled from the ocean while still alive but died anyway due to hypothermia. At Dachau, the Nazis decided to conduct research into the limits of cold endurance, as well as the most efficient and effective ways to rewarm hypothermic human beings. These particular experiments were conducted mostly in a part of the station known as Block Number Five. There the Nazis had installed a large wooden basin, two meters long and two meters high. The basin was filled with water, and ice was added until its temperature dropped to 37.4 degrees, a few degrees above freezing. Prisoners were immersed either naked or while wearing the standard flight suits of the German air force. Their temperatures were monitored through rectal thermometers, and they were typically kept in the basins until their bodies were chilled to 77 degrees, although they almost always lost consciousness at 89 degrees. Eventually they were removed, and attempts were made to resuscitate them. Some were wrapped in blankets, while others were subjected to more aggressive rewarming tactics. As Pacholegg told his interrogators, “another experiment conducted with these half-frozen, unconscious people was to take a man and throw him in boiling water of varying temperatures and take readings on his physical reactions from extreme cold to extreme heat. The victims came out looking like lobsters. Some lived, but most of them died. Scientifically I cannot understand how they lived.”

At the end of the interview, the army interrogators asked Pacholegg if there was anything else he wished to add about his time chronicling the activities at the Experimental Station. There was, he told them.

“I remember,” he said, “[that] any report I made out almost always ended with the remark ‘Experiment successful, but the patient died.' ”

The nine-page transcript of Anton Pacholegg's interrogation eventually became document number 2428 in the first trial conducted by the United States Nuremberg Military Tribunals after the war. The Doctors Trial, as it became known, had twenty-three defendants, all of them Nazis, most of them doctors, and the opening line of the prosecution's opening statement was blunt and clear: “The defendants in this case are charged with murders, tortures, and other atrocities committed in the name of medical science.” Indeed, “medical science” in Germany had been so corrupted, according to the chief prosecutor, that it demanded the coining of new words to describe it: “This case and these defendants have created this gruesome question for the lexicographer. For the moment, we will christen this macabre science ‘thanatology,' the science of producing death.”

The evidence against them was overwhelming. Apart from the damning eyewitness testimony from men like Pacholegg, the Nazis had meticulously documented their activities, producing a vast paper trail. In 1941, for example, a Luftwaffe physician named Sigmund Rascher, who would oversee the Experimental Station at Dachau, wrote a letter to Heinrich Himmler, the head of all medical services within the Third Reich. In the letter, Rascher lamented the fact that within the air force “no tests with human material had yet been possible for us, as such experiments are very dangerous and nobody volunteers for them.” Rascher also noted that the tests “theretofore made with monkeys had not been satisfactory” and inquired whether concentration camp inmates might be provided for him to use instead. An assistant of Himmler's immediately wrote back, informing Rascher that “prisoners will, of course, gladly be made available.”

Two years later, on February 17, 1943, Rascher sent an update to Himmler, this one including a short report on a new venture. The report, titled “Experiments for Rewarming of Intensely Chilled Human Beings by Animal Warmth,” chronicled the use of Gypsy women shipped in from the Ravensbrück concentration camp in northern Germany to warm some of the frozen male prisoners during the hypothermia experiments. “In eight cases the experimental subjects were then placed between two naked women in a spacious bed. The women were supposed to nestle as closely as possible to the chilled person. Then all three persons were covered with blankets.” The report included graphs depicting the relative rates of rewarming when one or two women were used, and noted that in certain rare cases the frozen men recovered sufficiently to perform sexual intercourse. In the cover letter to this report, Rascher mentioned that he was beginning to experiment with freezing the prisoners by simply “leaving them outdoors naked from 9–14 hours” in midwinter instead of using the ice water method, but that he believed such experiments would be better conducted elsewhere. “Auschwitz is in every way more suitable for such a large serial experiment than Dachau because it is colder there and the greater extent of open country within the camp would make the experiments less conspicuous (the experimental subjects yell when they freeze severely).”

The prosecution stressed that despite the clear monstrousness of the experiments, the monstrousness of the Nazis who conducted the experiments might be harder to recognize. In many cases, they did not conform to our usual understanding of what a monster is and isn't. “These defendants did not kill in hot blood, nor for personal enrichment,” the chief prosecutor said. “Some of them may be sadists, who killed and tortured for sport, but they are not all perverts. They are not ignorant men. Most of them are trained physicians, and some of them are distinguished scientists. Yet these defendants, all of whom were fully able to comprehend the nature of their acts, and most of whom were exceptionally qualified to form a moral and professional judgment in this respect, are responsible for wholesale murder and unspeakably cruel tortures.”

How was this possible?

The answer, according to the prosecution, was that the guiding principles of the Nazi state had caused a “moral degradation” of the German people and that moral degradation led to the physical degradation of other human beings. The crimes of the Nazi doctors, the prosecution argued, “were the inevitable result of the sinister doctrines which they espoused.”

The trial lasted for almost a year. By the time it was nearing its end, the prosecution had effectively demonstrated that the Nazi “investigators had free and unrestricted access to human beings to be experimented upon” and had treated them like disposable “human guinea pigs.”

The research conducted by the Nazis at Dachau and other concentration camps was perhaps history's most brutal and sustained example of inhumane human experimentation, but it wasn't the first. The broken have always illuminated the unbroken, and throughout history that breaking was often intentional. Around 300
B.C.E.
, in Alexandria, Egypt, two doctors named Herophilus and Erasistratus pioneered the craft of human dissection, and although most of their subjects were dead, there is evidence that some were not. Chronicling the work of those two doctors, the Ancient Greek historian Celsus described how, since “pains, and also various kinds of diseases, arise in the more internal parts, they hold that no one can apply remedies for these who is ignorant about the parts themselves; hence it becomes necessary to lay open the bodies of the dead and to scrutinize their viscera and intestines. They hold that Herophilus and Erasistratus did this in the best way by far, when they laid open men whilst alive—criminals received out prison from the kings—and whilst these were still breathing, observed parts which beforehand nature had concealed, their position, color, shape, size, arrangement, hardness, softness, smoothness, relation, processes, and depressions of each, and whether any part is inserted into or is received into another.” A couple hundred years later, during the first century
B.C.E.
, the Egyptian pharaoh Cleopatra supposedly ordered her own series of experimental vivisections on humans. At the time, there was a debate about whether male fetuses developed more slowly in the womb than female ones. In an attempt to settle the question, Cleopatra is said to have had a number of her own handmaidens forcibly impregnated, then dissected at various stages of their pregnancies while still alive.

Although vivisection was a rare extreme, the history of medical research is filled with unsettling experiments involving human beings. For example, in 1796, after noticing that workers on dairy farms almost never contracted smallpox, the British physician Edward Jenner decided to test a theory that this was because they had previously been exposed to the relatively benign disease known as cowpox. He made a series of small incisions in the arm of his gardener's son, eight-year-old James Phipps, then introduced the pus from a local milkmaid's cowpox blisters under Phipps's skin. During the following week, Phipps developed the mild fever, aches, and pains characteristic of cowpox, then recovered fully. Six weeks later, Jenner lanced his arm again and this time administered him smallpox, at the time the most deadly disease known to man. Phipps did not develop any symptoms, so Jenner exposed him again and again, twenty times in all, to no effect. Finally, Jenner concluded that he had discovered a smallpox vaccine. His discovery would change the world, leading not just to the eradication of smallpox but to the creation of modern immunology and the subsequent development of vaccines for hundreds of other diseases. Today it's possible to make a persuasive argument that Edward Jenner saved more human lives than any single person in history. Taking this into account, perhaps it's easy to argue that jeopardizing the life of an eight-year-old boy was acceptable.