This is essentially what happened to Mary Rafferty under the care of Dr. Roberts Bartholow.
Mary Rafferty was a domestic worker living during the late 1800s. She had immigrated from Ireland during the Great Famine to Cincinnati with her mother and four other siblings. Her life had its ups and downs--as a child, she fell into an open fire and permanently scarred her face and scalp--but she was known to be “cheerful in manner”, “smiled easily and frequently” and “did not hesitate for words”, or, in other words, she was chatty. She was also known as “feeble minded”, a term that I honestly think could mean nearly anything given the time period. (Harris)
Because of her burn scars, Mary usually wore a wig that was fastened with whalebone pieces. Around the Christmas of 1872, she noticed a small ulcer on her scalp. She figured that one of the whalebone pieces had rubbed against the spot and supposed that it would heal on its own.
Over the course of the next year, the ulcer did not heal. It instead grew until it eroded her skull and created a two-inch-diameter hole that exposed the surface of her brain. It was likely infected and pus would gather at the edges of the ulcer and leak out across her scalp. It gave a low, aching pain.
So, hoping for help from a good doctor, Mary went to the Good Samaritan hospital. She was met by Dr. Roberts Bartholow, who told her that she was “hopelessly diseased”, and that the ulcer threatened an “early extinction of life”. (Harris)
Bartholow had been simultaneously complimented for his intellect and drive and questioned for his utter lack of bedside manners. He “never had an intimate friend or even a close associate,” and his “frigid dignity, chilly reserve, and uninviting manner stood between him and his colleagues” (Harris). Bartholow “had no mercy for a weakling either in thought or in action”, which sets of alarm bells in my head due to Rafferty being described as “feeble minded”. One could only hope he was harsher to his colleagues than his patients, but one of Bartholow’s previous chemistry students, John Lloyd, again admired him for his intellect but also called him “cruel in his professional duties, when it came to physiological investigations”. He also said that Bartholow did “physiological investigations of drugs by the destruction of animal life” and that “Bartholow should have been criticised for his indifference to animal suffering”. (Harris)
Bartholow saw this as an opportunity. Here he had a patient with a window into her head. Bartholow wanted to contest the “doctrine of cerebral inexcitability”, which proposed that the cerebral cortex was for the senses, thoughts, and memories, but not for any kind of muscle movement. It was believed that muscle movement was the responsibility other structures, such as the corpus striatum (Harris).
Since the brain matter around the ulcer had already been damaged, he figured that “fine needles could be introduced without material injury.” He could then stimulate the underlying brain matter with an electric current. If it caused her muscles to move, it could help prove that the cerebral cortex had a part in controlling physical movement. (Harris)
However, using electricity to probe the cerebral cortex had some barriers. The electric charge could easily diffuse to other parts of the brain and cause reactions there, which could muddle results. It was also hard to tell if the bodily response was because the muscles were activated by electricity or if they were moved by instinctual responses to pain. The dura membrane surrounding the brain is also very sensitive, enough that “pinching it or stimulating it by electric current is sufficient to cause violent movements... Understandably, Bartholow did not remove the dura from Rafferty’s brain, but neither did he refrain from irritating it.” (Harris.)
Other researchers, such as Dr. Ferrier, Dr. Fritsch, and Dr. Hitzig, were testing their hypotheses in animal models, usually dogs and monkeys. However, they were acutely aware that the pre-experiment surgery and the electrical stimulation was really painful, and the animals were treated with anesthesia such as ether or chloroform before the experiments. Anesthesia lowered the brain’s “exciteability”, which meant that movement required more electric stimulation, but it prevented pain responses. This means that movements made during anesthesia were purely the result of the electricity. (Harris)
Dr. Ferrier’s experiments had mapped the motor centers of the brains in dogs and monkeys. While Ferrier believed that the monkey brain was pretty well analogous to the human brain, Bartholow was not completely convinced and stated that “animal studies must be complemented by similar investigations or by corresponding pathological alterations in the human brain.” (Harris)
Bartholow had also read other criticisms of Ferrier’s experiments that stated “by using strong faradic currents, the central ganglia [i.e., the thalamus and corpus striatum] of the base are called into action” (Harris.) Basically, the electric current could diffuse into other parts of the brain. It would be hard to tell if the resulting movement happened because of the cerebral cortex being stimulated or if it was from because of other parts of the brain being shocked. Bartholow wrote that he wanted to compare galvanic versus faradic currents for this reason and that they would be “tentative experiments” that would “[proceed] cautiously” (Harris.) I’d be interested to know what exactly he meant by ‘tentative’ and ‘cautious’. Perhaps he only meant that his conclusions would be this way, not the experiments themselves.
Mary consented to the experiment, but there is no record of how Bartholow explained it to her, if she understood what it would be, if she thought it would be therapeutic and cure the ulcer, or if her family was informed of her condition.
She was then taken to “The Electrical Room”, a small lab that Bartholow had constructed himself. It was full of large machinery, electrodes, and electrolytic needles. (Harris) Dr. Steely, the House Physician of the hospital, was also there to help and observe Bartholow as he worked.
The following content is going to detail the experiment that Bartholow performed on Mary Rafferty’s brain. It’s unpleasant and upsetting and honestly causes the same sort of queasiness that comes with learning about, say, Dahmer’s use of drills and acid. If you would like to learn more about this case but you don’t want to hear about the experiment itself, you can skip ahead to the next episode, which is going to be about the feedback that Dr. Bartholow received from other doctors after the experiment.
So, the electrolytic needles were 1.3 to 1.6 mm in diameter and 2 to 3 mm in length (Harris.) That’s a needle about as tall as 2 pennies stacked on top of each other and as wide as, well, the thickness of a single penny. This seems small, but that’s only the portion of the needle that actually releases the electricity into the brain and does not include the insulated section, which is slightly thicker. Electrolytic needles that are used today by comparison are generally 0.15 mm thick--or, the thickness of less than a tenth of a penny.
Bartholow did not use anesthesia in this experiment. It is also unclear if he expected any therapeutic benefit--certainly not for Mary Rafferty, but instead for patients in the future. Bartholow was a firm adherent of “applied medical science” and he believed that research should directly influence medical diagnostics and treatment. This is again kind of a case where kicking a kid may or may not prevent kids from being kicked in the future. If we discover where the motor control centers of the brain are now via electrostimulation, perhaps in the far future surgeries could be developed to treat motor control dysfunctions.
Bartholow began the experiment by bringing the needles in contact with the outer surface of the ulcer. Rafferty said that it hurt there, but that it did not hurt when the needles first pierced the brain via the dura mater. Mechanical stimulation, such as the insulated part of the needle pressing against the cortical tissue, caused no pain or sudden motion of her limbs (Harris.)
Bartholow then applied electricity to the dura using two needles. This caused Rafferty’s head to sharply and involuntarily jerk to the side. As the stimulation continued, Rafferty “‘‘complained of a very strong and unpleasant painful feeling of tingling in both right extremities, especially in the right arm, which she seized with the opposite hand and rubbed vigorously.” When Bartholow pushed the needles in further, she complained of “acute pain in the neck.”
In spite of the pain, she “smiled as if much amused.” This could have been an instance of “risus sardonicus”, or a facial spasm that looks a lot like a smile. This could have been caused by stimulation of the corpora quadrigemina, which Dr. Ferrier had noted in previous experiments.
In order to “develop more decided reactions”, because I guess acute pain and a rictus grin isn’t enough, Bartholow increased the current strength. Rafferty began to cry. Her face was contorted in pain. She extended her left hand out “as if in the act of taking hold of some object in front of her.” Her eyes became dry and fixed with her pupils blown out, her lips turned blue, and she began to froth at the mouth. She soon lost consciousness and convulsed violently for a full five minutes. She fell into a coma state for 20 more minutes. It is unclear if during any part of this period if Bartholow ceased stimulation, tried to remove the needles, or tried to help Rafferty at all.
After those 20 minutes, she regained consciousness and complained of mild “weakness and vertigo.” (Harris.) Shortly after this, Bartholow did another test, but with the current at a safer, lower level, but Rafferty still reported pain and tingling in her limbs, especially her hands.
After this experiment, Rafferty’s condition deteriorated. She was “pale and depressed, her lips were blue, and she had difficulty in walking, which she attributed to feelings of extreme dizziness. She also complained of numbness and tingling in her right arm, shoulder, and foot, and an examination showed paresis and rigidity of her entire right side.” (Harris) When she neared unconsciousness, she was told to lie down, and Bartholow had the observing Dr. Steely finally administer chloroform anaesthetic.
Bartholow observed her for the sixth and final time the day after anaesthesia. She remained in her bed, ill and in pain. Bartholow described her in his notes as “stupid and incoherent.” Later in the day, she had a 5 minute long convulsive seizure. Afterwards, her eyes went crossed and no longer responded to light or stimuli. Rafferty then lapsed into a coma, became completely paralyzed, and slowly died. Because of this, Bartholow did not perform the galvanic current trial that he had set up for the day.
Bartholow, who at most had a hand in Rafferty’s death and at the least performed an unethical, painful experiment on a likely disabled woman that he was aware would not be well received by the medical community, also performed Rafferty’s autopsy.
During the autopsy, he noticed that despite his assumption that “fine [electrolytic needles] could be introduced [into the cerebrum] without material injury”, even “fine needles cannot be introduce...without doing mischief.” The mischief, in this case, was vascularization and injury to the brain substance. The sections that were pierced by the needle also showed signs of liquefication, which is a symptom of glial scars.
Bartholow was aware that faradic current electrolysis could cause damage to cortical tissue, like increased vascularity, hyperemia--or an excess of blood, and haemorrhage from the sinuses--or nosebleeds. (Harris). However, when he observed a large thrombus, or blood clot, within the ulcer and part of the sinus cavity, he concluded that it happened independent of his experimentation. While this is possible, it is almost impossible to definitively prove.
While Bartholow had a goal to prove that the cerebral cortex was excitable and that there was homology in the brain between humans and other mammals, he merely concluded in his paper, “It has seemed to me most desirable to present the facts as I observed them, without comment.”
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