A Moral History of Human Guinea Pigs

About: G. Chamayou, Les Corps vils, La Découverte.

In November 2009, a World Health Organization study posted on the Lancet website stated that universal voluntary HIV testing followed by immediate antiretroviral therapy for all infected would strikingly reduce the incidence of HIV to one case per thousand per year by 2016. “To apply a mathematical model such as this, we would have to master a number of parameters,” remarked the director of the Agence Nationale de Recherche sur le Sida, in Le Monde, “including the screening of the 38 million people who are HIV-positive, 30 million of whom are not even aware of their condition, and who would have to accept therapy not so much for themselves as for the collective good.” That same week the murder, dismemberment, and sale for witchcraft of albino children in Burundi was made public. Nothing could be more dissimilar — at least one would think so — than a noble humanitarian ambition on a world scale and apparently ancient barbaric practices such as those in Burundi. Yet Grégoire Chamayou’s book, Les Corps vils, blurs the all too practical distinction between enlightened science — which strives for the good of all mankind — and superstition ¬— which is racist and criminal. He suggests that modern science has always depended, and probably continues to depend, on what he calls “dreadful rationality,” which implies the sacrifice of lives that are considered worthless and therefore available for exploitation.

The Hidden History of Scientific Progress

This is the story of a renewed outbreak, of a recurrence — in both the medical and legal senses of these terms, a story of risky medical experiments on the “vile bodies” — Furetière’s expression for “people of little importance” — that doctors allowed themselves to carry out. Grégoire Chamayou’s book analyses the various ways in which these bodies, either dead or alive, were acquired by doctors in the eighteenth and nineteenth centuries. It has been known for a long time (and ever since Robert Louis Stevenson it has been a favourite literary theme) that the medical sciences were connected with the criminal world and that bodies were dug up in cemeteries for dissection. It is less well known that the legal system also supplied doctors with even fresher corpses, those of criminals who had been executed. Here, Chamayou bluntly refers to an alliance between the scientist and the executioner on the one hand, and — since condemned criminals were offered freedom in exchange for agreeing to undergo a dangerous experiments — another between the scientist and the sovereign who thus delegated his right to pardon.

One might think that with the appearance in the nineteenth century of experimental medicine all this became a thing of the past. But according to Grégoire Chamayou, quite the opposite is true. While in the revolutionary period many doctors were opposed to the death sentence, in the nineteenth century, in their ivory tower of scientific neutrality, they remained silent and indeed used the institution to practice experiments on prisoners who had been condemned to death. Their other victims were prostitutes, the poor, and colonized peoples — all of them “vile bodies.” Claude Bernard supervised the last meals of condemned prisoners as part of his experimentation on the glycogenic function of the liver; Pasteur asked the emperor of Brazil for permission to experiment his vaccination against rabies on prisoners who had been condemned to death; and Koch (for the Bayer pharmaceutical laboratory) administered arsenic to indigenous populations interned in camps in Africa in the hope of understanding sleeping sickness.

As medicine moved from traditional experimentation (interested only in effects) to modern experimentation (interested in causes) it required more and more human guinea pigs. When experiments began to concern the etiology of various pathologies, it became necessary to inoculate healthy bodies with disease — children, for example, were inoculated with syphilis. This dark and hidden facet of the history of science culminated in the invention of the placebo, the use of which required not treating some patients who were nevertheless convinced that they were being treated. Thus, the organization of medicine on a mass scale sealed the divorce between scientific research and the doctor’s vocation to heal.

And the story does not end happily with new procedures that, at the beginning of the twentieth century, made it compulsory to draw up contracts and obtain consent. What can the meaning of consent be if it is given without full understanding of the risks incurred? Consent is often a fool’s bargain, or “specious rhetoric,” as Chamayou puts it. The same logic is at work when a condemned prisoner negotiates his corpse and when a person earns a living by exposing himself to the risks of experimentation. Karl Marx saw in the ancient figure of the vile body an image of the proletariat shamelessly exploited by Capitalism.

The Sophistry of Scientific “Neutrality”

Besides the constant reference to Marx, Grégoire Chamayou is clearly influenced by the work of Michel Foucault and his taste for the infamous. This is particularly apparent when he shows how the punishment invented by doctor Guillotin progressively became an experiment, or how colonial internment camps became ideal fields of experimentation for scientists. Yet Chamayou differs from his illustrious predecessor in a number of important ways. While Foucault emphasized fractures in the general conception of epistemological models, Chamayou is more faithful to the Marxist model and traces continuities. For him, exploitation is the iron law of history. The evolution of experimental medicine did nothing to change the hidden collusion between scientists and politicians, which on the contrary lasted and was renewed and even reinforced by technical change. Furthermore, while Foucault was interested primarily in an unconscious and overpowering archeology, as it were, Chamayou insists on the individual capacity for resistance. He essentially draws attention to crises of bio-power. Individuals are not crushed by historical determinism: “There is no single position of ‘the’ medical world that binds it monolithically and forever. Doctors do not all think alike and have conflicting ideas” (331).

The (fascinating) conflict between Diderot and D’Alembert on whether or not it was legitimate to organize mass inoculation was followed in the nineteenth century by another conflict, this time between unscrupulous doctors who thought that the working class was a vast field of experimentation kindly put at their disposal by society, and others, like Doctor Delpech, who thought it his duty to intervene and who published an essay on the diseases of workers in the rubber industry and demanded the organization of rules of public hygiene. It becomes apparent, then, that there are two positions concerning experimentation and its external conditions. On the one hand, there are those who wish to use experiments to “corroborate a theory,” on the other, those — with whom the author clearly sides — who wish to “undermine a practice” and thus turn medical expertise into critical discourse (336-337). He makes it clear that doctors tempted to advance their knowledge of the causes of disease, chose, relatively freely, either to ignore or to respect Hippocratic rules (do no harm, never submit a patient to risk). The greatest names in the history of medicine must face the tribunal presided by Kant, who was one of the few to oppose the experimental use of punishment as well as mass inoculation (followed by his disciple Markus Herz, when vaccinations were invented).

And what of science itself? Is it too called into question in this study? Chamayou does say that the neutrality of the scientist is a construction designed to conceal the sociopolitical foundation of scientific progress. His aim is to dismantle the myth of the unity of good and truth as it was celebrated at the end of the nineteenth century by scientism triumphant.

The book thus leads us to question the very nature of knowledge and truth procedures, which are by no means innocent — deeply rooted as they are in politics — and connected with the most shameful of discriminations — one that places part of the population at the service of another through various ideological or coercive means. The quest for knowledge does not automatically — by some miracle of nature — coincide with a quest for good, and seems instead to be the accessory of the blackest of collusions. This is so true that the “blindness as to the social conditions of one’s own scientific practice seems to have become a criterion of scientific soundness” (330). In other words, what science calls “neutrality” (the cliché “science doesn’t think” is significant here) is in fact a refusal to recognize the social and political conditions of its exercise (including experiments on vile bodies).

Any discussion of the unity of good and truth necessarily implies an encounter with Plato, referred to at the very beginning of the book in a sort of fable. Because it uses speech and reason to appropriate knowledge, Socrates places science among the arts of acquisition rather than production in The Sophist. “Platonic classification is disturbing because the acquisition of knowledge is placed next to the acquisition of game,” writes Chamayou. If, in the history of science, “science is like hunting,” it is hardly surprising that “human experimentation should suppose a sort of manhunt” (16). Chamayou appears here to be heading towards a critical genealogy of science, but in fact he distorts the text: Plato was not defining science in this passage but rather its imitation, sophistry. The sophist is to the philosopher what a wolf is to a dog: similar but with altogether different aims. Indeed, the sophist places knowledge at the service of utilitarian ends. In this particular case, the people he intends to seduce by promising to teach them political skills, are his game. Curiously, Plato, or Socrates, appears here to voice a concept he in fact condemned; especially since victims of politicians rather than politicians themselves are the game in question.

This difficulty can be felt from the moment the author says in his introduction, “my argument is that in the history of human experimentation the main form of acquisition has been the vilification of the subjects of experiments, whether that vilification was the result of the experiment or preceded experimental procedure that made a resource available for use” (17). In other words, are doctors responsible for having become accomplices of the circumstances of social domination or did they actually organize domination themselves? In fact, most of the examples provided by the author seem to say that the former is true and he mainly examines the sophistry scientists resorted to in order to justify their use of vile bodies. These arguments were not always produced by the scientists themselves but rather by philosophers, and in particular philosophers of the Enlightenment — Diderot foremost among them — and later utilitarians like Bentham and Mill, who explained that using criminals was a good way to allow them (and the poor in general) to pay their debt to society. Chamayou accuses Diderot of using the word mankind “rhetorically” (the criminal has placed himself outside mankind while the experimenter, despite his cruelty, works for the good of mankind, (73)). He finds those in favour of the inoculation of venereal disease guilty of what he calls “paralogical” argumentation (174) when they justify the use of prostitutes as guinea pigs by saying that they expose themselves to the dangers of infection anyway.

The book as a whole denounces the sophism — resorted to by those who practise experiments — that consists in taking the idea of mankind as an abstract entity (i.e. all humans, seen from the point of view of progress and the future, in the light of which the individual, particularly the criminal individual, is of no importance) and thus neglecting both present reality and the existence of power relations. “I argue that in ethics, the abstraction and indetermination of the subject are a way to make social relationships invisible,” he writes (388). This, of course, is a Marxist point of view ¬— reinforced with a bit of Kant — according to which the logic of the sacrifice of the few for the many is an imposture, a hypocritical argument in other words. Chamayou seems to be saying that medical sciences are unable to cure some humans without rejecting and killing others — ones that have been blackened and vilified beforehand. Science, then, is essentially discriminatory and criminal. Chamayou accuses many scientists, and perhaps even Science itself, of a kind of sophistry that does not only require paralogical argumentation and rhetorical sleight-of-hand. In his view it is a moral flaw — perhaps even a crime against humanity.

The Acquisition and Production of Vile Bodies

Because the means by which bodies are acquired and the ways in which they are vilified overlap, the process of vilification becomes a way of producing vile beings that are both exemplary and yet excluded from the ranks of humanity. They may be used without scruple by the ruling classes for whatever purpose they like. Rather than asking about mankind in general (is it permissible to carry out experiments on humans?), Chamayou shows that the question only ever concerned certain specific categories: on which humans was it permissible to do experiments? This is where he finds the medical sciences as a whole guilty of sophistry. Vile bodies, scientists argued, don’t exist in nature. If they can be used for experiments, the results of which are applied to all humans, it follows that they are of the same nature as “noble” bodies. Thus vile bodies are vile “only because they have been made vile, have been produced as such” (19). And doctors who take advantage of their vilification are objectively hypocrites (347). Naturally equal but socially unequal: that is the core contradiction, the kind of sophism that feeds the authors indignation. Chamayou writes both as a historian and a moralist here, as if his aim were to vilify the exploiters of vile bodies. But is it really true that scientists themselves produce vilification, or that scientific neutrality is no more than a mask, or that modern science is structurally criminal? For the author, questions like these remain unanswered, just as the course of history, which he sees as the sum of individual efforts, remains undetermined. It is not clear whether Chamayou wishes to take a moral stand — the medical researcher must and therefore can always treat his patient as an end in himself and never as a means — or to show that moral laws are incapable of answering the quandaries of the age of progress — universalization being self-contradictory in practice or being successful only where Kant prohibited it (with vaccination, for example).

What remains, and makes this work of history so apposite, is its analysis of the temptation that the medical sciences (formerly the medical arts) have always been faced with. The question is no longer one of knowing in order to cure, but one of hurting in order to know. Has science not been tempted in this way ever since Bacon declared that “the nature of things betrays itself more readily under the vexations of art than in its natural freedom”? In what measure can it be said that scientific neutrality — which ignores any disturbing facts — is criminal or a party to a crime? Hasn’t every patient once felt himself to be a “vile body” beneath the kindly but cold gaze of a necessarily paternalistic doctor? Les Corps vils is concerned with both history and morals, which is why it is puzzling but exciting to read. The types of experiments described in the book (particularly those using electricity) conjure up dark thoughts of Mary Shelley and the Promethean temptation that faces modern science, to create a new and pure man with the sacrificed bodies of criminals and other social rejects.

First published in www.laviedesidees.fr. Translated from French by Virginia Ricard.