La première partie du livre porte sur le XIXe siècle et compte cinq

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La première partie du livre porte sur le XIXe siècle et compte cinq chapitres. Il
y est question des théories médicales avant la bactériologie, du développement
de l’enseignement, de l’évolution de l’hôpital, de celle des soins médicaux et de
l’organisation de la profession. Une des faiblesses de cette partie est de présenter
les questions relatives à l’organisation de la médecine durant la première moitié du XIXe siècle sous l’angle d’une lutte entre francophones et anglophones,
et non comme celle des praticiens locaux et de certains immigrants (irlandais,
américains, etc.) contre le patronage, l’arbitraire de l’administration coloniale,
et l’état de subordination et de marginalisation dans lesquels ils se trouvent. La
deuxième partie du livre couvre le XXe siècle. Elle comprend 16 chapitres et son
contenu est le plus nouveau. Les auteurs y font d’excellents bilans de l’évolution
de la formation médicale, du système hospitalier, des traitements, de la relation médecins-patients, de la médecine préventive, de l’approche biomédicale.
Deux chapitres m’ont particulièrement intéressé. Le chapitre 9 sur la grande
chirurgie décrit comment l’évolution des procédés anesthésiques, des mesures
d’asepsie, des connaissances sur les groupes sanguins et la transfusion sanguine
ont ouvert la voie aux grandes opérations abdominales, aux opérations thoraciques et à celles du cerveau. Le chapitre 16 traite quant à lui de l’évolution de
la recherche médicale au Québec au cours des 50 dernières années. On y trouve
un aperçu des principaux instituts de recherche et une description de leurs
domaines d’activité : cancer, anatomie-pathologique, neurologie, psychiatrie,
cardiologie, maladies respiratoires, maladies génétiques, etc.
L’ouvrage s’appuie sur une vaste documentation mais on n’y trouve pas
de comparaisons avec les autres provinces. Les détails sont nombreux et on
accorde beaucoup d’importance aux pionniers, novateurs, fondateurs, etc., ce
qui rend parfois le texte lourd. Souvent, les sources à l’origine des graphiques
ne sont pas données. Souvent aussi, le lecteur s’attendrait à ce que certaines
affirmations soient plus étayées, par exemple lorsqu’il est dit qu’on fit même
« des appendicectomies préventives » dans les années 1930 (220), ou que le Dr
Georges Cousineau a été le premier à introduire l’anesthésie intraveineuse au
Canada (224). Par contre, l’ouvrage est très bien illustré.
Cela dit, cet ouvrage constitue une très bonne synthèse de l’évolution de la
médecine au Québec au cours des 2 derniers siècles et il devrait occuper une
place importante dans les facultés de médecine. Il intéressera certainement aussi
tous les citoyens qui s’interrogent sur le passé et l’avenir de la médecine dans
notre société.
JACQUES BERNIER Université Laval
Against Their Will: The Secret History of Medical Experimentation on
Children in Cold War America
Allen M. Hornblum, Judith L. Newman, and Gregory J. Dober
New York: Palgrave Macmillan, 2013, x + 266 p., $31.00
Against Their Will opens with an account of Charlie Dyer, a resident of the Fernald State School in the 1950s, who was pressured at age 12 to join the “science
club,” an innocuous name for the radiation experiment unknowingly conducted
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on at least 74 adolescent boys diagnosed with developmental disabilities. Boys
like Charlie were considered suitable test subjects for the Harvard and MIT scientists who fed them radioisotope-laced milk each morning to test the effects of
radiation exposure. Readers of Michael D’Antonio’s The State Boys Rebellion will
be familiar with Fernald’s horrific history and the successful class action lawsuit
launched by surviving test subjects in the 1990s. Against Their Will shows that
the Fernald case was not an aberration, but a tradition spanning three quarters
of the 20th century where the top scientists and physicians in the United States
routinely experimented on orphaned, mentally ill, disabled, and poor infants,
children, and adolescents. Rather than simply produce a catalogue of appalling and heartbreaking cases of abused and forgotten children, authors Hornblum, Newman, and Dober identify the political and scientific rationale driving
research with underage and vulnerable participants. In addition to being an
impressively detailed piece of medical history, Against Their Will contributes
to the history of childhood by acknowledging how and why certain cohorts
of children remained powerless across 20th-century America, even as vast
improvements were being made to child health and child rights.
Unsurprisingly, the authors of Against Their Will situate the origins of their
study in the early 20th century when eugenics was considered a credible science. Through social reform and more radical social engineering like sterilization, doctors and other followers sought to improve or eliminate pockets of
society characterized as flawed. This coincided with the heroic age of medicine
which witnessed the eradication of several diseases, granting doctors celebrity
status and greater respect. Given that “[m]edical triumphalism had taken hold
of a hero-obsessed culture,” the authors position this era as a time where “little
thought was given to those caught in the wake of the latest scientific success”
(22). Against Their Will’s unique contribution to this dark era of medical history is
to show how human experimentation on vulnerable populations in the United
States continued and even flourished long after eugenics went out of fashion
after the Second World War. The authors note the hypocrisy of the American
medical community condemning the Nazi experiments on concentration camp
prisoners, while simultaneously conducting research on vulnerable populations
at home and abroad. They show that the American medical community appears
to have collectively ignored the 1947 Nuremberg Code, 10 principles crafted by
two American doctors meant to protect subjects of human experimentation with
conditions such as informed consent. Instead, the competitive spirit of Cold War
science, combined with the fears about communist domination and nuclear war,
meant that “medical progress” would “supersede the interests of the subject”
well into the 1970s (45).
During both the eugenic and Cold War eras, medical experiments were commonly conducted on vulnerable adults: the incarcerated, the disabled, senior
citizens, low income populations, and racial minorities, including the infamous
Tuskegee Syphilis experiments on African American men in rural Alabama. With
these subject pools available to scientists, the authors consider why so many
children became the subjects of medical research. One reason for using young
people was a growing interest in finding cures for childhood illnesses and in
studying early developmental stages, neither of which had equivalent adult test
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subjects. In the name of saving “normal” children, those whose futures held an
opportunity to be productive adult citizens, doctors thought it was an acceptable risk to test vaccines on the bodies of “abnormal” youngsters, those with
physical or cognitive handicaps that were perceived to make lives less worthy.
This mindset allowed Dr. Koprowski, for example, to feed live polio viruses to 20
children at a New York asylum. The chapter on psychiatric experiments is particularly chilling as surgeons and non-surgeons tested the benefits of lobotomies
on children as young as five in hopes that the procedure would curtail anxiety,
aggression, sullenness, autism, and schizophrenia.
Beyond treating specific childhood diseases, Against Their Will argues that
convenience was a major factor for using children, particularly those who were
institutionalized. Researchers were provided with subjects conveniently housed
in one space, already under some form of surveillance, available for the long
term, and who usually had a controlled diet and other forms of regimentation
ideal for comparable test data. Most importantly, unlike their adult counterparts, due to their young age, small sizes, legal status, lack of education, and in
some cases inability to communicate orally, the children did not have the individual agency to challenge their involvement. When parents were present, they
were often equally without agency—impoverished single mothers, for example,
whose access to free medical care was dependent on participation in clinical trials for themselves or their children. It was not until experiments like Tuskegee
came to light in the 1970s, combined with organized parental advocacy for disabled children that a revised set of ethics came into practice for medical research
with human participants.
Since only partial records have survived, the authors are unable to quantify
exact effects on youth or even the total number of deaths resulting from the various studies. Still there is overwhelming evidence from autopsy reports, medical
files, published articles, and tissue samples that record the short- and long-term
trauma felt by young participants who were injected or fed or immersed in
often toxic or dangerous substances. When possible, the authors let the now
grown adults or their surviving relatives tell their stories, where they express
confusion, shame, and anger. One memorable account is by Hazel Potter Dornbush, a participant of what later became known as the “Monster study,” a 1939
experiment in negative therapy that turned non-stuttering orphans into lifelong
stutterers in order to understanding triggers of the condition. In reference to the
study, Dornbush states, “I call that brainwashing. I don’t care what anybody
else calls it, that’s my language. I was wise to it right away, but I cooperated.
You know you were weren’t in no [sic] position to argue with nobody. We had
nobody to lean on to help us out”(185).
Against Their Will is a thorough and thoughtful survey of the wide-ranging
experiments on preventatives and treatments conducted on youth across the
20th century, and what they represented in terms of American medical achievements and ethics as well as the professional and societal indifference toward
children whose social status deemed them expendable. Ian Mosby’s recent
research on dietary experiments on indigenous youth in Canadian residential
schools suggests this trend extended beyond the United States. Comparative
transnational studies would be valuable in understanding the specific local,
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national, and international contexts triggering such experimentation, along with
when, where and which children’s freedoms and bodies were sacrificed in the
name of scientific advances.
TARAH BROOKFIELD Wilfrid Laurier University
“Regimental Practice” by John Buchanan, M.D. An Eighteenth-Century
Medical Diary and Manual
Edited by Paul Kopperman
Farnham, Surrey (UK) and Burlington (VT): Ashgate, 2012. xiii + 231 p.,
$124.95 hard cover; $94.95 Kindle
James Buchanan (1710–67), was apprenticed to an Edinburgh surgeon in 1729,
commissioned a surgeon in a famous cavalry regiment (“the Blues,” or “Blews”
as he spelled it) in 1734, but only saw military action beginning in 1742, in Flanders during the War of the Austrian Succession. He resigned his army post in
1746 and began private practice in Staffordshire. How, when, and where he
earned his claimed “M.D.” is unknown. Shortly after he left the army, he began
work on the manuscript that is the subject of the volume reviewed here. He
revised it up to the time of his death, but never published it. It is preserved in
the Wellcome Library as RAMC 1037, and can be viewed electronically, though
without good legibility, through the library’s web site.
In essence, the work is a medical “journal” that starts with his experiences
on the regiment’s embarkation for expected battle in Flanders. Presumably,
Buchanan accumulated notes of his military experiences, which he began to
write up four years later, after leaving the army. The rationale for the order of
the disorders covered is primarily chronological. He describes initially seasickness among the men and his approach to management. Of interest, the first
illness encountered among the men once they land is “The Itch.”
Kopperman provides brief introductory material on Buchanan’s life and
medical career, his medical education, and a section on how his experience
affected “his understanding of the cause and cure of disease.” The rest of the
volume is a detailed transcription of the 349 pages of Buchanan’s manuscript
(many simply noted as blank). An entrancing aspect of the medical journal
is the frequent citation of quotations from Latin authors of antiquity, Horace,
Cicero, etc., apposite to the clinical case discussed. Buchanan also cites 13 different works by Hippocrates, who is by far the most frequently quoted authority.
Galen gets a single reference. Avicenna none.
Buchanan ends his work with a list of “Authors on Military Diseases & Gunshot wounds,” although the war for the regiment was so desultory that his regiment saw relatively few “bullet” wounds. Of interest, Paracelsus is noted (Traite
des Arquebusades), but like other works on the list not cited anywhere in the text,
suggesting Buchanan may not have read them. Extraordinarily, Ambrose Paré
is not even listed.
The longer version of this work is published electronically with a different
title: Theory and Practice in Eighteenth century British Medicine: “Regimental Practice,” by James Buchanan, M.D. The reader can access the manuscript without