Maurice Henry Pappworth
Encyclopedia
Maurice Henry Pappworth was a pioneering British medical ethicist
and tutor, best known for his 1967 book Human Guinea Pigs, which exposed the unethical dimensions of medical research. Born and educated in Liverpool, Pappworth graduated as a Bachelor of Medicine, Bachelor of Surgery in 1932 from Liverpool University. After working in a series of junior medical positions, his applications for more senior posts were rejected because of his Jewish parentage. In the Second World War he served in the Royal Army Medical Corps
. Having been unsuccessful in achieving a post in any well known London hospital after the war, he set up in London as an independent medical consultant and tutor.
Pappworth's teaching of postgraduate students had a profound effect on the Membership of the Royal College of Physicians
(MRCP) examination pass rate, and his contact with junior doctors led him to investigate the ethics of medical research on humans. The publication of Human Guinea Pigs, which examined unethical medical research practices, exposed the subject to a wider audience and led to Pappworth's becoming persona non grata within the medical establishment for much of his career, but ultimately helped lead to stricter codes of practice for human experimentation.
and passed the MRCP exam, after which he worked in several Liverpool hospitals in junior roles—including as a registrar under Henry Cohen
. Before the Second World War, Pappworth sought a medical consultant role only to suffer from anti-Semitic discrimination, being told that "no Jew could ever be a gentleman" when he applied for a post in 1939. That position eventually went to a student whom he had coached for the MRCP exam. From 1941 to 1946, he served in the Royal Army Medical Corps, rising to the rank of lieutenant colonel and serving in Africa, Italy, Greece and finally India, where he ran a British general hospital. In 1946, Pappworth moved to London, where his applications for prominent medical positions were rejected. He turned down several lesser posts before setting up as an independent consultant. In 1953, he married Jean Goldberg; the couple went on to have three daughters.
—then not inconsiderable—for a two-hour class, Pappworth began teaching in his consulting rooms, later moving the classes to a public hall in London. He also staged mock examinations in nearby mental hospitals for a higher cost. The pass rate for Pappworth's students was "outstandingly good"; sometimes more than half of those who passed the exam had been taught by him. Over the course of his career, Pappworth tutored more than 1,600 doctors, many of whom were from overseas. He claimed that 75 percent of the successful New Zealand and Australian candidates could trace their success to his teaching. Many working consultants in the United Kingdom admit Pappworth's influence on the success of their careers. While recognized as the best medical teacher in the country, Pappworth was unafraid of speaking his mind about the medical establishment; equally, the Royal College of Physicians
did not withhold criticism of Pappworth's unwanted encroachment into its affairs. In 1960, Pappworth's lectures were published as A Primer of Medicine. It ran to three editions, but lacked the comprehensive and incisive nature of his spoken lectures.
, so Pappworth began writing letters to medical journals that had presented the research. Many of these went unprinted, so in 1962 he published fourteen of the letters as Human Guinea Pigs: A Warning in a special edition of Twentieth Century magazine.
Pappworth made plans to publish an extended version of his article as a book. Human Guinea Pigs: Experimentation on Man named those responsible for the research and fully cited its sources. It detailed experiments on children and inmates of mental and penal institutions, and included 78 examples of research that had been carried out on patients who were at National Health Service
hospitals for routine surgery. Some of these patients had been subjected to cardiac catheterization
—the insertion of a catheter
into a chamber
or vessel
of the heart
—without informed consent. Pappworth believed the reasons for the experiments to be purely for the career advancement of those involved. Pappworth was advised by the medical establishment to keep quiet on the issue, but he refused. The first publishers he approached declined the book on legal grounds, but Human Guinea Pigs was eventually published in 1967 by Routledge and Kegan Paul
.
The book's publication provoked an immediate storm; newspaper and television coverage of the issue followed, as well as questions in Parliament
. Pappworth's American contemporary Henry K. Beecher
, with whom Pappworth had corresponded before and after Human Guinea Pigs publication, had published similar findings in the New England Journal of Medicine
in 1966, but had not named those involved. Despite official disinterest and professional impedance, Pappworth's and Beecher's work eventually led to the introduction of stricter codes of practice for human experimentation and the establishment of research ethics committees, which would have come much later had it not been for their exposés.
Towards the end of his life, he wrote an article in the British Medical Journal
that included his view that "those who dirty the linen and not those who wash it should be criticized. Some do not wash linen in public or in private and the dirt is merely left to accumulate until it stinks". Pappworth continued to be disregarded by the medical establishment. For example, election to a fellowship of the Royal College of Physicians is usually a formality awarded after passing the MRCP—which Pappworth did in 1936—and after being in practice for ten to fifteen years. He was not awarded a fellowship until 1993, when changes in the corridors of power made this possible.
Pappworth's interests outside medicine included photography, fine art and watercolours
, philosophy, religion, and politics. He died on October 12, 1994 of coronary heart disease
at his London home; he was survived by his wife and three daughters.
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
and tutor, best known for his 1967 book Human Guinea Pigs, which exposed the unethical dimensions of medical research. Born and educated in Liverpool, Pappworth graduated as a Bachelor of Medicine, Bachelor of Surgery in 1932 from Liverpool University. After working in a series of junior medical positions, his applications for more senior posts were rejected because of his Jewish parentage. In the Second World War he served in the Royal Army Medical Corps
Royal Army Medical Corps
The Royal Army Medical Corps is a specialist corps in the British Army which provides medical services to all British Army personnel and their families in war and in peace...
. Having been unsuccessful in achieving a post in any well known London hospital after the war, he set up in London as an independent medical consultant and tutor.
Pappworth's teaching of postgraduate students had a profound effect on the Membership of the Royal College of Physicians
Membership of the Royal College of Physicians
Membership of the Royal Colleges of Physicians is a postgraduate medical diploma. The examinations are run by the Federation of the Medical Royal Colleges of the United Kingdom – the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College...
(MRCP) examination pass rate, and his contact with junior doctors led him to investigate the ethics of medical research on humans. The publication of Human Guinea Pigs, which examined unethical medical research practices, exposed the subject to a wider audience and led to Pappworth's becoming persona non grata within the medical establishment for much of his career, but ultimately helped lead to stricter codes of practice for human experimentation.
Early life and education
Born Maurice Henry Papperovitch on January 9, 1910, Pappworth was the second child in a family that included three sons and six daughters. He graduated from Liverpool University's medical school in 1932 as Bachelor of Medicine, Bachelor of Surgery, after previously studying at the Birkenhead Institute. In 1936, he received his medical doctorateDoctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
and passed the MRCP exam, after which he worked in several Liverpool hospitals in junior roles—including as a registrar under Henry Cohen
Henry Cohen, 1st Baron Cohen of Birkenhead
Henry Cohen, 1st Baron Cohen of Birkenhead CH, FRCP was a British physician, doctor and lecturer. He was famous for his Harveian Oration at the Royal College of Physicians in 1970, on the motion of blood in the veins....
. Before the Second World War, Pappworth sought a medical consultant role only to suffer from anti-Semitic discrimination, being told that "no Jew could ever be a gentleman" when he applied for a post in 1939. That position eventually went to a student whom he had coached for the MRCP exam. From 1941 to 1946, he served in the Royal Army Medical Corps, rising to the rank of lieutenant colonel and serving in Africa, Italy, Greece and finally India, where he ran a British general hospital. In 1946, Pappworth moved to London, where his applications for prominent medical positions were rejected. He turned down several lesser posts before setting up as an independent consultant. In 1953, he married Jean Goldberg; the couple went on to have three daughters.
Postgraduate teaching
In the 1950s, the pass rate for the MRCP examination seldom topped fifteen percent, partly due to the medical establishment's need to restrict the number of applicants to senior positions, but also—Pappworth maintained—because of low teaching standards in medical schools. Almost no preparation for the MRCP exam was given to postgraduates, so Pappworth resolved to tutor qualified doctors in the particulars of medicine and patient examination that the exam required. Charging one poundPound sterling
The pound sterling , commonly called the pound, is the official currency of the United Kingdom, its Crown Dependencies and the British Overseas Territories of South Georgia and the South Sandwich Islands, British Antarctic Territory and Tristan da Cunha. It is subdivided into 100 pence...
—then not inconsiderable—for a two-hour class, Pappworth began teaching in his consulting rooms, later moving the classes to a public hall in London. He also staged mock examinations in nearby mental hospitals for a higher cost. The pass rate for Pappworth's students was "outstandingly good"; sometimes more than half of those who passed the exam had been taught by him. Over the course of his career, Pappworth tutored more than 1,600 doctors, many of whom were from overseas. He claimed that 75 percent of the successful New Zealand and Australian candidates could trace their success to his teaching. Many working consultants in the United Kingdom admit Pappworth's influence on the success of their careers. While recognized as the best medical teacher in the country, Pappworth was unafraid of speaking his mind about the medical establishment; equally, the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
did not withhold criticism of Pappworth's unwanted encroachment into its affairs. In 1960, Pappworth's lectures were published as A Primer of Medicine. It ran to three editions, but lacked the comprehensive and incisive nature of his spoken lectures.
Human Guinea Pigs
In the 1950s and 1960s, Pappworth became concerned by descriptions in medical journals of unethical experiments on human subjects in the United Kingdom and United States; his growing awareness of the issue was reinforced by the concerns of his postgraduate students, who sometimes had no choice but to facilitate and participate in such experiments or face career ruin. The experiments went against the principles set out in the Nuremberg CodeNuremberg Code
The Nuremberg Code is a set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War.-Background:...
, so Pappworth began writing letters to medical journals that had presented the research. Many of these went unprinted, so in 1962 he published fourteen of the letters as Human Guinea Pigs: A Warning in a special edition of Twentieth Century magazine.
Pappworth made plans to publish an extended version of his article as a book. Human Guinea Pigs: Experimentation on Man named those responsible for the research and fully cited its sources. It detailed experiments on children and inmates of mental and penal institutions, and included 78 examples of research that had been carried out on patients who were at National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
hospitals for routine surgery. Some of these patients had been subjected to cardiac catheterization
Cardiac catheterization
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes...
—the insertion of a catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
into a chamber
Heart chamber
aHeart chamber is a general term used to refer to any chambers of the mammalian heart. The heart consists of four chambers: the right and left atrium and the right and left ventricle. The top chambers are connected to the bottom chambers by valves and are separated by the coronary sulcus...
or vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
—without informed consent. Pappworth believed the reasons for the experiments to be purely for the career advancement of those involved. Pappworth was advised by the medical establishment to keep quiet on the issue, but he refused. The first publishers he approached declined the book on legal grounds, but Human Guinea Pigs was eventually published in 1967 by Routledge and Kegan Paul
Routledge
Routledge is a British publishing house which has operated under a succession of company names and latterly as an academic imprint. Its origins may be traced back to the 19th-century London bookseller George Routledge...
.
The book's publication provoked an immediate storm; newspaper and television coverage of the issue followed, as well as questions in Parliament
Parliament of England
The Parliament of England was the legislature of the Kingdom of England. In 1066, William of Normandy introduced a feudal system, by which he sought the advice of a council of tenants-in-chief and ecclesiastics before making laws...
. Pappworth's American contemporary Henry K. Beecher
Henry K. Beecher
Henry Knowles Beecher was an important figure in the history of anesthesiology and medicine, receiving awards and honors during his career. His 1966 article on unethical practices in medical experimentation within the New England Journal of Medicine was instrumental in the implementation of...
, with whom Pappworth had corresponded before and after Human Guinea Pigs publication, had published similar findings in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in 1966, but had not named those involved. Despite official disinterest and professional impedance, Pappworth's and Beecher's work eventually led to the introduction of stricter codes of practice for human experimentation and the establishment of research ethics committees, which would have come much later had it not been for their exposés.
Later career and personal life
It has been suggested that the unintended consequence of this exposure was Pappworth's becoming persona non grata within the medical establishment. His critical nature may have been partly to blame for this, as he not only continued to admonish Royal College of Physicians, but also alienated some of those in the medical establishment that were sympathetic to his cause; Pappworth's personal comments about specific consultants quickly distanced his audience when he was invited to speak to the residents at Hammersmith Hospital, whose medical school he had criticised in Human Guinea Pigs for its unethical methods. Pappworth's attitude towards students could also leave them feeling "ignorant, foolish, and humiliated".Towards the end of his life, he wrote an article in the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
that included his view that "those who dirty the linen and not those who wash it should be criticized. Some do not wash linen in public or in private and the dirt is merely left to accumulate until it stinks". Pappworth continued to be disregarded by the medical establishment. For example, election to a fellowship of the Royal College of Physicians is usually a formality awarded after passing the MRCP—which Pappworth did in 1936—and after being in practice for ten to fifteen years. He was not awarded a fellowship until 1993, when changes in the corridors of power made this possible.
Pappworth's interests outside medicine included photography, fine art and watercolours
Watercolor painting
Watercolor or watercolour , also aquarelle from French, is a painting method. A watercolor is the medium or the resulting artwork in which the paints are made of pigments suspended in a water-soluble vehicle...
, philosophy, religion, and politics. He died on October 12, 1994 of coronary heart disease
Coronary disease
Coronary disease refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. It is already the most common form of disease affecting the heart and an important cause of premature death in Europe, the Baltic states, Russia, North and South...
at his London home; he was survived by his wife and three daughters.