 It is the 9th of December 1946 and 23 men are led into courtroom 600 at the Palace of Justice, Nuremberg, Germany. This marks the beginning of a fascinating yet chilling Nuremberg doctors' trial. Part one of the indictments laid at the defendant's feet was war crimes, performing medical experiments without the subject's consent on prisoners of war and civilians of occupied countries, in the course of which experiments, the defendants committed murders, brutalities, cruelties, tortures, atrocities and other inhuman acts. The trials aimed to prove and hold responsible those who conducted truly horrific experiments on prisoners at a number of concentration The evidence was plentiful and damning, ranging over several gruesome experiments on both live and dead subjects, including the study of malaria. A difficult case to rebut, but the defense counsel thought they had an ace up their sleeve. The US had been studying malaria as well, in a widely publicized experiment, and on the face of it similarly on imprisoned individuals, albeit the stateside experiments involve criminals and not victims of genocide. But the defense's attempt at what aboutism has meant that the prosecution now needs to show the difference, and this will bring in a questionable expert witness. Although USA versus Karl Brandt et al is a fascinating court case that would lead to the vital Nuremberg code, today we are focusing on the study that offered a glimpse of hope for the evil men on the stand in 1946 to 1947. My name is John and we're delving into the 1944 Stateville Penitentiary Malaria study. Welcome to the dark side of science. Our story starts with the USA's entry into World War II, with Japan launching multiple attacks on US and British holdings in Asia and the West Pacific. Pretty soon, the full power of the American military was brought to bear, and this resulted in thousands of soldiers being deployed to the Pacific and Africa. A long known hazard to soldiers working in tropical and sub-tropical zones has been that of malaria. This mosquito-borne infectious disease has throughout history stopped armies in their tracks. The diseases symptoms include fever, tiredness, vomiting and headaches. This is caused by mosquito bites transmitting single-celled microorganisms of the plasmodium group, the most deadly of which, plasmodium falchiparum, has a history closely linked with our own. When around 10,000 years ago, its population exploded, around the same time humans became an agrarian species. As populations grew in towns and cities, so did plasmodium falchiparum. The bite passes the parasites into the victim's body and into the bloodstream, from there they pass the liver and reproduce, with symptoms beginning to be shown between 10 and 14 days. For reference, in the year 2020, there were 241 million worldwide known cases, of which 627,000 were fatal. But even if you don't die from malaria, you won't have a great time if untreated. Relapses can happen for years after exposure. The best way to defeat malaria is to prevent infection in the first place. As such, mosquito nets are an essential part of life in parts of the world where malaria is common. The evolution of treatment followed many wars and colonial disputes in the first half of the 20th century. Pre-1920s, quinine was the main form of treatment. It is derived from the tree Chincona calicea. It was discovered by the indigenous peoples of Peru, who used it as a muscle relaxant. And with most great things from South America, it was taken and exploited by Europeans from the 16th century. It was later discovered by Jesuit, Agostino, Sal Eubrino and Apothecary by training, who lived in Lima, observed the quechua using the bark of the tree to treat shivering, a common symptom of malaria. Anyway, to cut a long story short, it was found to be an effective treatment for malaria. And throughout the 1800s, became a crucial component in the colonization of Africa by Europeans, which could be a dark side of science video in its own right. During the First World War, blockades of Germany resulted in restricted access to Chincona calicea, which by now was grown in South America and in Dutch plantations in Java and Sumatra. This led to the first successful synthesis by German scientist Peter Mullens, resulting in the drug Parmaquine or Plasmochin. The drug, although very effective at killing malaria, was also effective at killing people if treatment wasn't closely supervised. This was discovered when the drug was tested on United Fruit's West Indian African Descended Workforce. Ah, lovely, the story just keeps on getting darker and darker. Of course, these impoverished laborers were not given informed consent of the treatment with a new drug. As Japan swept through Asia in the late 1930s and early parts of the 1940s, the Allies were cut off from the vital Dutch plantations, which by the 1930s produced over 90% of the world's supply of quinine. With dwindling stocks of the drug, the age old foe of an army came back with a vengeance. And this was the issue the US Armed Forces were facing in the Second World War. In 1942, the US Army Medical Corps were estimating 251 cases per 100,000 troops of malaria. Needless to say, this can be a massive drain on military resources, and not surprisingly searches for more effective treatments were a top priority for militaries around the world. This is where the University of Chicago comes into our story. Starting in July 1941, the newly created US Committee of Medical Research sought out to find the most effective treatment of malaria sufferers. Their plan was twofold. Firstly, to attempt to source quinine from the South American market, which by now was pretty derelict after Dutch dominance in their plantations. And secondly, to develop new malaria drugs. The committee found human testing desirable, as it would speed up drug development and the study of the disease. Malaria would, however, not be the first for human experimentation, as the US military had several experiments running looking at many illnesses linked to maintaining an army, such as STDs. Although eager to use human subjects, a number of rules were set, including, when any risks are involved, volunteers only should be utilised as subjects. And these, only after the risks, have been fully explained, and consent forms would be required to be signed for later access. But who to use? The military was not eager to use their own soldiers, as well they were needed for soldiering. But there were two sections of society that in the eyes of military officials had a debt to pay. The first was conscientious objectors, and the second, prisoners. The latter would be preferable, as they offered unique opportunity in that their environment was completely controlled, thus offering the perfect human guinea pigs. A contract was drafted with the University of Chicago to launch an investigation into the disease. Just 30 miles south of the University of Chicago would be the setting for the study. State Phil Penitentiary was, at the time of the experiment's conception, just under 20 years old. It featured a roundhouse based on Jeremy Bentham's Panopticon concept, a layout that would help the experimenters more than they would know. You see, the Panopticon architectural design is a stroke of genius. Prisons have always had one big issue, and that is how to constantly surveil their prisoners. The Panopticon concept fixes this by placing every cell entrance on a walkway around the circumference of a roundhouse. A tower is built in the centre. This allows guards in the tower to be able to observe any prisoner at any time. But the prisoners view the tower is obscured, which means they can't see if the guards are watching them. This in theory results in the concept of constant supervision, as you can't tell whether or not you're being watched. As such, the prisoners self-regulate their behaviour and act as if they are always being watched. And this would help the experimenters throughout the study. The team was headed up by Alf Sven Alving, a neurologist at the University of Chicago. Much of the team were doctors just past residency doing their military service. Interestingly, the prisoners would also be employed not just as subjects, but as technicians. They would study two types of malaria, P vivax and P fauciparum. The former is mild, but causes repeat relapses of sickness, and the latter is short-lived but can be deadly. However, most tests were performed with vivax, as it was more common in Asia. Before the study began, mosquitoes were bred at the University of Chicago and infected with the chest and strain of vivax. The source of malaria came from a US soldier who had been infected in the Pacific campaign. During the setup of the experiment, the prison warden allocated the top floor of the prison hospital for the study. This was away from the roundhouse and thus gave a kind of relief to the prisoners of constant supervision. Initially, the participants were immune to any punishment, but quickly this was revoked when the request was put out for participation beginning in March over the prison radio over two times the required 200 men applied for the first round of experiments. The opportunity for earlier parole and a payment of between $25 and $100 also didn't hurt. Each infected mosquito was kept inside a circular plastic cage with a gall's bottom. This allowed the cage to be placed on the subject's skin and the mosquito to bite without escaping. The subjects selected were sentenced for longer than 18 months. This allowed an almost 100% follow-up rate and were all white men of a similar age and health. A medical history was taken and physical examinations were made on the candidates. In addition, a complete blood count, urinalysis, blood typing, chest x-ray and electrocardogram were undertaken on the subjects. Deliberately infecting a person with malaria wasn't a new thing, however. It was actually a form of treatment of syphilis in the early 1900s, pre the discovery of penicillin. The favourite produced was enough to kill the temperature-sensitive syphilis bacteria. The patient would then be treated later on for malaria with quinine. But I digress. The inmates were usually infected in groups of three, two of whom would be used to test out potential anti-malarial drugs with the final person acting as a control by not receiving anything. However, sometimes the infection group would be done in just pairs. As part of the infection process, one mosquito would be used to infect all three men, and each man would be bitten by 10 mosquitoes in total. After infection, the mosquitoes would be dissected, usually by a technician who was actually a prisoner. But infection is just the start of the experiment. Testing of potential drugs came next. For the prophylactic tests, the drugs were administered to the inmates the day before infection, the day of infection, and for six days after. They were encapsulated in gelatin, and were strictly controlled to ensure the right doses were issued. This test was to see if any drugs could prevent the onset of malaria, or at least reduce its symptoms. Blood tests were taken after the eighth day post infection. At the same time, temperature and pulse measurements were taken. Subjects were admitted to hospital when fever and symptoms became too much to handle in their cell. During any hospitalization period, rectal temperatures, pulses and respirations were monitored every four hours. If the fever ran above 103 degrees Fahrenheit, then this would be increased to every 30 minutes. Every day, blood pressure, urine samples, fluid intake, and special tests to establish drug toxicity were taken. The next set of tests were aimed at curative treatments, that is to stop sickness after the onset of disease. The curative tests could make use of previous participants, as long as the prophylaxis test had failed in the individual or they had been used as a control. They would be administered drugs once their temperature had exceeded 103 degrees Fahrenheit. This is where various different versions of synthetic quinine would be tested at four hour intervals. In a typical scenario, this could be for around 14 days. Throughout the study, over 30 new compounds were tested on the volunteers at Stateville, one of which was Primer Queen and the study marked the first case of human testing of the compound. They also tested analogues of Pammer Queen, an existing alternative to quinine but had high toxicity levels. These analogues were tested in the human subjects, even though their toxicity was not fully known, thus risking the health of the participants. Some doses were increased past what was known to be safe in order to observe the side effects of the substances. The testing of SN8233 resulted in one prisoner's death after it caused a heart attack. Many subjects were complained of heart conditions after the studies. The experiment allowed the military to find out how much of each analogue could be administered before adverse side effects would be felt. There is no doubt, however, that the experiment proved useful, especially in saving the lives of Allied soldiers. But we need to talk about the ethical considerations. Although the study for its time was considered an ethical milestone by getting written consent from its participants, the administrators still left a lot of the risks, shall we say, unexplained. The form only stated that the prisoner was agreeing to take part in investigations of the life cycle of the malarial parasite, and to accept all risks connected with the experiment. Pretty vague by modern standards. But the idea of informed consent is hard to define, especially when the participants are in an inherently coercive environment. The motives of the subjects can be pretty much split into three groups. Mercenary, for the money on offer. Corporal, in the sense that the punishing life of prison may be lessened. Or philosophical, in that participation offered a feeling of working towards a greater good for the war effort. An notorious participant was Nathan Leopold, who would later insist it was pure altruism that led him to volunteer. Leopold, along with an accomplice, were serving a life sentence for the kidnap and murder of Bobby Franks. He would be paroled in 1958, partially influenced by his time during the malaria study. Even amongst large swathes of the prison population, the war at the time was seen as a good thing. The pitching of good versus evil and all that. So really the question is how unethical were the actions of the research team. They most certainly made most of the use of the prisoners, in that I can't think of any other population that could be tested on with potentially lethal drugs and society not be too concerned. Even with volunteers from the civilian or military world, the testing of unknown drugs couldn't be done. As in the eyes of the public, a death from Eva would be considered a tragedy, something that is unlikely for a prisoner. It is really open for debate, the ethics of the study. Something that is still questioned today. And this brings us back to 1946 and 1947, during the Doctors Nuremberg trial. The malaria study at the time was widely publicised, leading to it being the most well known top secret project. It even featured in Life magazine. As such, and in preparing an argument for their clients in the USA versus Karl Brandt trial, the defence council sought to compare the German malaria study undertaken in concentration camps to the Statefield study. Even though the US study by today's standards stands on ethically shaky ground, the crimes committed in the name of science at Dachau are on another level. Talking specifically about the malaria study, the victims in the concentration camps were not given any form of information about what they would have to endure, let alone being asked about participation. It is estimated that around 1200 people were used to test malaria at Dachau. Approximately half would die. Any who received any debilitating side effects but survived were murdered. Needless to say, in the Doctors trial, this poor defence of what aboutism didn't work. And out of the 23 defendants, 7 would be acquitted, 7 be given the death penalty and the remaining serving various terms in prison. In the wake of the trial, a new code for human experimentation was set out, and that would take the name of the city, Nuremberg. Ironically, the experiments used to defend the perpetrators, if compared to the new code, would actually have failed to meet its standards. The malaria study would continue past the Second World War, and some really bizarre experiments would happen with prisoner-to-prisoner drug transfusions. But that would be a story maybe for another time. Now where would you rate this subject on my ethical scale? 1 being all okay, and 10 being pure evil. I'm going to say around a 3. This is a plain difficult production. All videos on the channel are creative commons attribution share alike licensed. Plain difficult videos are produced by me, John, in the currently sunny corner of south London, UK. Help the channel grow by liking, commenting and subscribing. Check out my Twitter, all sorts of odds and sods, and hints on future videos. I've got YouTube membership and Patreon as well, so check them out if you fancy supporting the channel financially. If you like the outro music on this video, please make your way over to my second channel made by John, and all that's left to say is Mr Music, play us out please.