Ethics and experiments

Test Tubes and Turpitude: Artificial Insemination and the

Medical Profession in Mid-Twentieth-Century Scotland

This paper stems from ongoing research into the interface between infertility, health and sexuality in post-WWII Scotland. The project examines reproductive pathologies, technologies, and ethics in terms of both the formulation and medical implementation of policy, attempting to gauge how medical ideologies and agencies interacted with broader socio-legal concerns and processes. Such considerations are set within a geographically localised context which asks whether there was a distinctively Scottish response to the politics of reproduction given Scotland’s separate traditions of law, local government and medical practice, and the enduring social significance of religion.

In 1958, a Departmental Committee wasappointed to investigate the existing practice of human artificial insemination (AI) as a means to treat infertility, and to consider whether any change in the law was necessary to protect the interests of specific individuals or society as a whole. The wide range of witnesses – legal, medical and religious – approached to give evidence and the voluminous evidence submitted give rich insights into the complexsocial politics and anxieties surrounding infertility and its treatment through AIin 1950s Britain.

This paper will focus upon the written and oral evidence submitted by Scottish medical witnesses in order to gain insight into the ideology and practice of AI. It is intended thereby to contribute to two areas of weakness within the historiography of British sexuality and reproductive health. Themajority of this literature has focused upon legal and moral politics rather than the role and perspective of the medical profession;and there has been a distinct tendency to centre – explicitly or implicitly – upon the metropolis of London. This paper aims to provide an important clinical and provincial perspective to the history of reproductive health in twentieth-century Britain.

Dr Gayle Davis, University of Edinburgh,

School of History, Classics and Archaeology,

Historicizing a Medical Technology of the Future: the Emergence of the Stem Cell Concept and the Connection with Tumour Research

Over the past ten years an international discourse on the medical, ethical, religious, social and legal implications of embryonic stem cell research has developed. Remarkably, however, the history of this research area has been little explored. Perhaps this is the case because the focus is so much on the future possibilities of new, stem cell based, regenerative therapies for conditions such as Parkinson’s disease, diabetes mellitus, Alzheimer’s disease, spinal cord injuries and cardiac insufficiency. This therapeutic optimism is coupled with strong metaphors, such as the notion of the pluripotent stem cell ‘superhero’: capable of virtually anything, last hope for the suffering, but also requiring difficult moral choices (Lawrence Burns 2009).

In this paper I would like to discuss the quite different meanings and connotations of embryonic stem cells during the late nineteenth and early twentieth centuries when they were first conceptualized. Ernst Haeckel, the controversial German propagator of Darwinism and zoology professor in Jena, introduced the term ‘stem cell’ in the late 1860s in the context of his ‘biogenetic law’ that ontogeny represents a shortened and rapid recapitulation of phylogeny. The notion of stem cells was soon taken up by other zoologists and anatomists and became established in studies on early embryonic development and the blood-forming system. ‘Stem cells’ or related terms such as ‘mother cells’, ‘primordial cells’ and ‘germ cells’, carried meanings of common heritage and equality in authors who compared the organisation of the human body with the social arrangements of the state (Rudolf Virchow, Ernst Haeckel, Oscar Hertwig). However, the theory of the Breslau pathologist Julius Cohnheim that aberrant, residual embryonic cells might form tumours later in an individual’s life, turned stem cells also into potentially dangerous entities. First formulated in the late 1870s, ‘Cohnheim’s theory’ was still intensely discussed in medicine in the early years of the twentieth century and led to numerous animal experiments that aimed at producing tumours through implantation of embryonic cells.

The theory continued to be relevant for the understanding of mixed tumours or teratomas, when in the early 1950s Leroy Stevens in the Jackson Laboratory in Bar Harbor, Maine, embarked on an extensive research programme on this type of tumour and its ‘embryonal’ cells in mice. While these tumour cells were cancerous, they also produced embryo-like (‘embryoid’) bodies when transferred from one mouse into the abdomen of another mouse; and normal early embryo cells could produce a teratoma when transplanted into the testes of mice. Moreover, as Beatrice Mintz and Karl Illmensee at the Institute for Cancer Research in Philadelphia showed in 1975, teratoma cells were ‘tamed’ to support normal development if implanted into an early mouse embryo. Embryonic stem cells thus appeared to have an ambiguous nature, partly ‘good’ as the origins of normal development, and partly ‘bad’ as potential sources of cancer. This historical ambiguity of embryonic stem cells, however, seems to have played not much of a role in the public discourses after the research groups of James Thomson and John Gearhart had announced the isolation of human embryonic stem cell lines in 1998. Pushed by biotech companies such as Geron, the ‘superhero’ image of embryonic stem cells began to emerge, while bioethicists hurried to negotiate the ethical costs of harvesting them from early human embryos.

Prof. Holger Maehle

Centre for the History of Medicine and Disease, Durham University, UK

From the ‘Wilkes Report’ to the ‘End of Life Care Strategy’

The development of governmental policies on care for the dying in England since 1980

The establishment of St Christopher’s Hospice in London in 1967, is widely regarded as the birth of modern hospice care. The developments in England were emulated in other countries. Currently, the organisation of care for the dying is a topic on the political agenda in many nations.

This paper consists of three parts. Firstly, I will give a concise overview of the main policy documents on care for the dying. This survey starts with the ‘Wilkes report’, which was published in 1980 and was the first policy document on care for the dying in England, and finishes with the ‘End of Life Care Strategy’, which is currently being implemented.

Secondly, I will discuss the relationship between policies on care for the dying and cancer policies. This analysis shows that the policies on care for the dying became increasingly focused on care for incurable cancer patients as cancer policy became a topic that featured highly on the political agenda from the late 1990s. The publication of the ‘End of Life Care Strategy’ in 2008, however, appears to constitute a turning point, because the concept of care for the dying employed in this policy document shows important similarities with the notion of terminal care used in the ‘Wilkes Report’.

Finally, I will highlight some characteristics of the policy developments in England that might be relevant for policymakers concerned with care for the dying in other countries.

Ellen van Reuler

Centre for the History of Science, Technology & Medicine

University of Manchester