Willowbrook State School Case Study

Willowbrook State School was a state-supported institution for children with intellectual disability located in the Willowbrook neighborhood on Staten Island in New York City from 1947 until 1987.

The school was designed for 4,000, but by 1965 it had a population of 6,000. At the time, it was the biggest state-run institution for people with mental disabilities in the United States.[1] Conditions and questionable medical practices and experiments prompted Sen. Robert Kennedy to call it a "snake pit".[2] Public outcry led to its closure in 1987, and to federal civil rights legislation protecting people with disabilities.

A portion of the grounds and some of the buildings were incorporated into the campus of the College of Staten Island, which moved to Willowbrook in the early 1990s.

Construction and early conversion[edit]

In 1938, plans were drawn up to build a facility for children who had an intellectual disability on 375 acres (152 ha) in the Willowbrook section of Staten Island. Construction was completed in 1942, but instead of opening for its original purpose, it was converted into a United States Army hospital, and named Halloran General Hospital, after the late Colonel Paul Stacey Halloran. After World War II, proposals were introduced to turn the site over to the Veterans Administration, but in October 1947, the New York State Department of Mental Hygiene opened its facility there as originally planned, and the institution was named Willowbrook State School.

Hepatitis studies[edit]

Throughout the first decade of its operation, outbreaks of hepatitis, primarily hepatitis A, were common at the school. This led to controversial medical studies being carried out there between the late 1950s and the '70s by medical researchers Saul Krugman (New York University) and Robert W. McCollum (Yale University), who monitored subjects to gauge the effects of gamma globulin in combating it.[3] A public outcry forced the research project and medical studies to be discontinued. Accusations were leveled that the researchers had used mentally disabled children as "human guinea pigs," but the chief critic of the project — New York SenatorSeymour R. Thaler of Queens — later conceded that the work had been conducted properly.[3] One result of the research was a better understanding of the differences between serum hepatitis, – which is spread by blood transfusions, – from infectious hepatitis, which is spread directly from person to person and is the more common form.[3]

Paul A. Offit described Krugman's studies as follows:

In an effort to control outbreaks of hepatitis, the medical staff at Willowbrook consulted Saul Krugman.... Krugman found that hepatitis developed in 90 percent of children admitted to Willowbrook soon after their arrival. Although it was known that hepatitis was caused by a virus, it wasn't known how hepatitis virus spread, whether it could be prevented, or how many types of viruses caused the disease. Krugman used the children of Willowbrook to answer those questions. One of his studies involved feeding live hepatitis virus to sixty healthy children. Krugman watched as their skin and eyes turned yellow and their livers got bigger. He watched them vomit and refuse to eat. All the children fed hepatitis virus became ill, some severely. Krugman reasoned that it was justifiable to inoculate retarded children at Willowbrook with hepatitis virus because most of them would get hepatitis anyway. But by purposefully giving the children hepatitis, Krugman increased that chance to 100 percent.[4]

According to the celebrated vaccinologist Maurice Hilleman, "They [the Willowbrook studies] were the most unethical medical experiments ever performed on children in the United States."[5] Historian David Rothman notes that, "The research was even included in Henry Beecher's 1966 New England Journal of Medicine listing of "ethically dubious" experiments."[6] Bioethicist Art Caplan has stated that, "The Willowbrook studies were a turning point in how we thought about medical experiments on retarded children... Children inoculated with hepatitis virus had no chance to benefit from the procedure — only the chance to be harmed."[7]

Scandals and abuses[edit]

By 1965, Willowbrook housed over 6,000 intellectually disabled people despite having a maximum capacity of 4,000. Senator Robert Kennedy toured the institution in 1965 and proclaimed that individuals in the overcrowded facility were "living in filth and dirt, their clothing in rags, in rooms less comfortable and cheerful than the cages in which we put animals in a zoo" and offered a series of recommendations for improving conditions.[8] Although the hepatitis study had been discontinued, the residential school's reputation was that of a warehouse for New York City's mentally disabled people, many of whom were presumably abandoned there by their families, foster care agencies, or other systems designed to care for them. Donna J. Stone, an advocate for mentally disabled children as well as victims of child abuse, gained access to the school by posing as a recent social work graduate. She then shared her observations with members of the press.[9]

A series of articles in local newspapers, including the Staten Island Advance and the Staten Island Register, described the crowded, filthy living conditions at Willowbrook, and the negligent treatment of some of its residents. Jane Kurtin was the first reporter to write a story about Willowbrook State School because she visited Willowbrook in order to cover a demonstration that social workers and parents of the residents had organized.[10][11] Kurtin wanted to get inside the buildings, and social workers Elizabeth Lee and Ira Fisher brought her inside. Shortly thereafter, in early 1972, Geraldo Rivera, then an investigative reporter for WABC-TV in New York, conducted a series of investigations at Willowbrook uncovering a host of deplorable conditions, including overcrowding, inadequate sanitary facilities, and physical and sexual abuse of residents by members of the school's staff. The exposé, entitled Willowbrook: The Last Great Disgrace,[12] garnered national attention and won a Peabody Award for Rivera.[13] The original Willowbrook documentary remains available for public viewing on Rivera's website [1]. Rivera later appeared on the nationally televised Dick Cavett Show with film of patients at the school. As a result of the overcrowding and inhumane conditions, a class-action lawsuit was filed against the State of New York by the parents of 5,000 residents of Willowbrook in federal court on March 17, 1972. This was known as New York ARC v. Rockefeller. Elizabeth Lee's employment was terminated in 1972 as a result of her activism with the parents.[14]

In 1975, a consent judgment was signed, and it committed New York state to improve community placement for the, now designated, "Willowbrook Class". The publicity generated by the case was a major contributing factor to the passage of a federal law — the Civil Rights of Institutionalized Persons Act of 1980.

Closure[edit]

In 1975, a Willowbrook Consent Decree was signed that committed New York state to improve community placement for the now designated "Willowbrook Class."[15]

In 1983, the state of New York announced plans to close Willowbrook, which had been renamed the Staten Island Developmental Center in 1974. By the end of March 1986, the number of residents housed there had dwindled to 250, and the last children left the grounds on September 17, 1987. After the developmental center closed, the site became the focus of intense local debate about what should be done with the property. In 1989, a portion of the land was acquired by the city of New York, with the intent of using it to establish a new campus for the College of Staten Island, and the new campus opened at Willowbrook in 1993. This campus is the largest maintained by the City University of New York. Within the year, one of CSI's two other existing campuses, located in the Sunnyside neighborhood, was closed, renovated, and reopened in 1995 as the home of the new K-12 Michael J. Petrides School. The rest of Willowbrook's original property is still under the administration of the Office for People with Developmental Disabilities (OPWDD)–an agency of New York State –and houses the New York State Institute for Basic Research in Developmental Disabilities, and the Staten Island Developmental Disabilities Service Office.

On February 25, 1987, the Federal Court approved the Willowbrook "1987 Stipulation," which set forth guidelines that required OMRDD (Office of Mental Retardation and Developmental Disabilities; renamed the Office for People with Developmental Disabilities, OPWDD, in July 2010) community placement for the "Willowbrook Class."[15] The Willowbrook School was closed that year. All but about 150 of the former Willowbrook residents were moved to group homes by 1992. Significant members of the "Willowbrook Class" were not as intellectually limited as the term "developmental delay" would indicate. Some had cerebral palsy, a developmental disability that can be accompanied by varying degrees of intellectual impairment, and some members of this class were cognitively quite intact, yet unable to communicate verbally due to their physical condition. These ex-residents of Willowbrook, many now in their 50s and 60s, live in a variety of community residences and attend day programs throughout New York State, under the care of organizations such as United Cerebral Palsy or the Jewish Guild for the Blind.

In the 1991 book, The Soul of a Cop, retired NYPD Detective Paul Ragonese describes responding to "building two" of the abandoned Willowbrook campus as a member of the NYPD Bomb Squad. Ragonese describes an abandoned building full of hazardous chemicals, including explosive picric acid crystals, along with rooms full of jars containing specimens of human organs. Ragonese goes on to write that the incident was largely covered up by local officials.[16]

Former students[edit]

In 1997, Danny Aiello hosted, and Geraldo Rivera served as commentator for, a 57-minute documentary titled, Unforgotten: 25 Years After Willowbrook, which revisits Staten Island's Willowbrook State School, "remembering the over 5,000 children who were living in the facility at the time and focusing on three former residents, to see how the effects of the institution have been felt by families and friends of patients as well."[17] Writes The New York Times reviewer, Stephen Holden:

As graphically as it recounts the horrors of the past, Unforgotten is less concerned with raking the coals of an old scandal than with showing how the treatment of the mentally disabled has since improved. The film [...] focuses on the lives of two who were once incarcerated at Willowbrook but subsequently flourished in group homes situated in close proximity to their families. / A third longtime resident of Willowbrook, Bernard Carabello, is also interviewed. Mr. Carabello, who suffers from cerebral palsy, spent 18 years at Willowbrook after being misdiagnosed as mentally retarded at the age of 3. / In looking at the lives of Patty Ann Meskell and Luis Rivera (who died shortly after the film was completed), both of whom spent many years at Willowbrook, the movie stresses their essential humanity. Each is shown interacting with loving family members who are still deeply stung by memories of visits to Willowbrook more than 25 years ago. / The film, narrated by Danny Aiello, isn't so much an investigative documentary as a blunt plea for the humane treatment of the mentally retarded. It also warns that despite changes in social attitudes (the Special Olympics are cited as a shining example of progress), Willowbrook could happen again. Remembrance is a vital key to the prevention of future abuse.[18][19]

In March 2009, a fire in a residence in upstate Wells, New York, killed four members of the "Willowbrook Class".[20]

Willowbrook State Hospital is mentioned in the 2009 documentary movie Cropsey as having reportedly housed convicted child kidnapper Andre Rand, who had previously worked there as an orderly.[21] One of Rand's supposed victims, Jennifer Schweiger, was found buried in a shallow grave behind the grounds of the abandoned Willowbrook State School, which was built under the same design as Pilgrim State Hospital.

In 2011, a former resident of Willowbrook State School, a savant named Anthony Torrone, wrote a Christianprayerbook titled Anthony's Prayers that was inspired by his time and the abuse he experienced at the school.[22][23]

See also[edit]

References[edit]

  1. ^The Praeger Handbook of Special Education - by Alberto M. Bursztyn - Praeger Publishers; 1 edition (December 30, 2006)ISBN 0-313-33262-2
  2. ^A Guide to Willowbrook State School Resources at Other Institutions Retrieved August 25, 2009
  3. ^ abcHevesi, Dennis. "Robert W. McCollum, Dean of Dartmouth Medical School, Dies at 85",The New York Times, September 25, 2010. Accessed September 26, 2010.
  4. ^Offit, Paul A. (2007), Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases, New York: Smithsonian Books/Collins, pg 27.
  5. ^Offit, Op. cit., pg 27.
  6. ^Rothman, David (1982). "Were Tuskegee and Willowbrook 'Studies in Nature'?". The Hastings Center Report. 12: 5–7 – via JSTOR. 
  7. ^Offit, Op. cit., pg 27.
  8. ^Staff (September 10, 1965). "Excerpts From Statement by Kennedy". The New York Times. Retrieved September 26, 2010. 
  9. ^Rivera, Geraldo (1972). Willowbrook: A Report on How it is and Why it Doesn’t Have to Be That Way. New York: Random House. ISBN 0-394-71844-5. 
  10. ^http://www.npr.org/templates/story/story.php?storyId=87975196
  11. ^http://www.silive.com/news/2017/01/the_horrors_of_willowbrook_sta.html
  12. ^Rivera, Geraldo (1972). Willowbrook: The Last Great Disgrace. WABC-TV. [dead link]
  13. ^Powers, Ron (1977). The Newscasters: The News Business as Show Business. New York: St. Martin's Press. p. 185. ISBN 978-0312572075. 
  14. ^JOHN SIBLEY (February 4, 1072). Commissioner Won't Reinstate Two Dismissed at Willowbrook The New York Times
  15. ^ abMilestones in OMRDD's History, OMRDD, (2001-09-19). Retrieved 2007-09-05.
  16. ^The Soul of a Cop, Paul Ragonese & Barry Stainback, 1991 St. Martins Press0
  17. ^Cammila Collar, Rovi. "Review Summary - Unforgotten: 25 Years After Willowbrook (1997), Alternate title: Unforgotten: Twenty-Five Years After Willowbrook". The New York Times. Retrieved June 2013. 
  18. ^STEPHEN HOLDEN (February 14, 1997). "Movie Review: Unforgotten 25 Years After Willowbrook (1997): A Plea for Treating People Humanely". The New York Times. 
  19. ^Unforgotten: Twenty-Five Years After Willowbrook. City Lights International. 1997-02-14. 
  20. ^TRACY CONNOR / DAILY NEWS STAFF WRITER (March 21, 2009). "'Willowbrook Class' members killed in fire at group home; were part of infamous suit vs. S.I. school". New York Daily News. 
  21. ^Cropsey. Philadelphia, Penn.: Breaking Glass Pictures. 2011. 
  22. ^Anthony Torrone. Anthony's Prayers: A simple book by Grand Rapids Anthony Torrone, a grateful survivor. 
  23. ^http://www.silive.com/worship/2012/01/my_lord_savior_god_helped_me_s.html 'My Lord Savior God helped me survive'

Further reading[edit]

  • Grossman, Joel B. (Winter 1987). "Beyond the Willowbrook Wars: The Courts and Institutional Reform". American Bar Foundation Research Journal. 12 (1): 249–259. doi:10.1111/j.1747-4469.1987.tb00536.x. 
  • Klein, Joel (February 4, 1985). "The Lawyers' Plot". New Republic. 192 (5): 28. 
  • Peele, Roger (September 1, 1985). "The Willowbrook Wars". The American Journal of Psychiatry. 142 (9): 1111–a–1112. doi:10.1176/ajp.142.9.1111-a. 
  • Rothman, David J.; Rothman, Sheila M. (October 1984). The Willowbrook Wars. Harper & Row. ISBN 978-0-06-015234-5. 

Coordinates: 40°35′58″N74°09′02″W / 40.59944°N 74.15056°W / 40.59944; -74.15056

As Dr. Saul Krugman strolled through the grounds of the Willowbrook State School of Staten Island in the early 1950’s, he became overwhelmed with excitement. The directors of the school had earlier asked Krugman, an infectious diseases expert at New York University Medical Center, to investigate why many of the children were struck with infectious diseases at the school and what could be done about it ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 158). Krugman found that hepatitis was highly endemic at the school; he claimed over 90% of children had hepatitis at Willowbrook ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 159). He saw a place to further pursue his research, which would go on to receive wide acclaim. Krugman’s research at the school would lead incredible discoveries about the nature of hepatitis. Krugman himself would be admitted into the National Academy of Sciences and win countless awards, including the prestigious Lasker Award (Saul Krugman—Awards). However, Krugman’s story is far more complex than a triumph over hepatitis. Krugman’s research involved intentionally infecting children at the school with the disease. To make matters worse, the Willowbrook State School was not a traditional school, but instead a school for children with intellectual disabilities. The Krugman case is thus complex, full of ethical questions essential to the practice of productive and reputable research. Critics have hotly debated Krugman’s claims that he acted ethically, and logical arguments can be made for both sides. Nevertheless, what is clear is that Krugman’s research and its criticisms clearly show the duality of medicine: the conflict between maximizing benefit to an individual patient versus maximizing the benefit to society.

Before looking at the research, one must understand why and how Krugman was able to do his work, and that involves starting with the Willowbrook State School. The New York Legislature authorized its construction in 1938, and at first, in the post-war era, it was a hospital for veterans. In 1951, it was converted to its original purpose, a school for the intellectually disabled (Rothman, 23). Krugman wrote that 60% of the population were not toilet trained and 64% were unable to feed themselves. Not only were the patients severely mentally handicapped, but the school was well over capacity. Within four years of opening, the number of residents exceeded the official capacity by 700. That number ballooned by 1963, when 6,000 residents lived in a space designed for 4,275 (Rothman, 23). The school was infamous for its poor conditions. In 1965 Senator Robert Kennedy described Willowbrook’s wards as “less comfortable and cheerful than the cages in which we put animals in a zoo” (Rothman, 23). It is not surprising with these conditions that hepatitis and other infectious diseases, such as measles, became endemic within the wards.

Dr. Saul Krugman was always interested in vaccines and he became a key player in both the measles vaccine in the early 1960’s and a rubella vaccine in the mid-1960’s (The NYU Physician). Thus, it was only natural then he turned his eye toward hepatitis and took on the opportunity to do comprehensive hepatitis research to hopefully discover a vaccine.

Krugman and his team began their experiments at the Willowbrook School around 1955, and their findings regarding the nature and treatment of hepatitis over the next 15 years would be staggering. In his own words Krugman hoped his research would “shed new light on the natural history and prevention of the disease—new knowledge that could conceivably lead to the development of a vaccine” ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 159). Krugman knew that due to the cramped, crowded conditions of the Willowbrook School, hepatitis was easily spread and a high percentage of the population had the disease. Because children were already at a high risk of contracting the disease, the ethical ramifications of intentionally giving the children the disease was not a concern to Krugman. In addition, Krugman’s epidemiological surveys had shown infections of hepatits in children had much milder symptoms. Krugman would carefully monitor the children who were part of the study, ensuring they had specially trained staff and lived in an isolated unit that was significantly better maintained than the rest of the Willowbrook School (Krugman, 1020).

The findings from Krugman’s work at Willowbrook were nothing short of groundbreaking. One of the important aspects of the research was the identification of two distinctive strains of hepatitis. Krugman was the first to distinguish between MS-1 and MS-2 strains of hepatitis, which are more commonly referred to as hepatitis A and B ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 161). Based on this discovery, Krugman’s focus shifted towards discovering the pathways by which the two strains spread. He found that hepatitis A spread through the fecal-oral route, while hepatitis B spread through intimate physical contact and the transfer of body fluids ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 161). With his end goal always being a vaccine, Krugman made a major breakthrough in 1970, 15 years from the start of his study. He developed a prototype of an inactivated hepatitis B vaccine that would be the basis for the eventual hepatitis B vaccine. His vaccine was rather simple: by taking serum from the plasma of those with hepatitis B, diluting it in a 1:10 ratio with distilled water, and boiling the mixture, he found he could create a non-infectious, but protective vaccine ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 161).

Though Krugman’s goals and results from the experiments were clear, his methods were morally questionable. While his critics focused on the harm done to the patient, Krugman believed his research was justified as it helped so many more than it may have harmed.

“My colleague, the late Dr. Joan P. Giles, expressed it beautifully and succinctly in her letter to the Lancet, published May 29, 1971, in which she said, "A farmer may pull up corn seedlings to destroy them or he may pull them up to set them in better hills for better growing. How then does one judge the deed without the motive?" This describes the motivation for our studies at Willowbrook State School” ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 161).

Krugman put forth a utilitarian viewpoint. His research undoubtedly maximized the well-being of future generations. This is one way to look at being a physician, and it certainly is a rather macroscopic view. The other way to look at being a physician is maximizing the well-being of the patient. Did Krugman attempt to do this? His critics argued otherwise.

One troubling aspect of Krugman’s experiments was the concept of consent. Krugman’s methods of obtaining consent were ethically valid; he extensively informed parents of the risk and rewards of the experiment, gave them a tour of the facilities, and allowed them to ask any questions of the social workers that would be taking care of their children (Krugman, 1020). Issues arose in the Willowbrook experiments because there was an inherent bias toward giving consent for your child to participate in the experiments. The quality of care was significantly higher in Krugman’s isolated unit than the rest of the Willowbrook school, such that parents would have been more likely to exchange their children’s health for better care. Another critical issue was that Willowbrook was already over capacity, and one email exchange implied that entering the hepatitis ward was the only way for children on the waiting list to gain entrance to the school (Letter from Dr. Jack Hammond to Miss Muriel McInerney). Both of these issues again speak to systematic issues in how Willowbrook was run. Therefore, is it possible to blame Krugman? Perhaps not, it was not his responsibility after all to fix the institution. Nevertheless, Krugman made no efforts to promote change, and in fact defended the director of the Willowbrook State School, Dr. Jack Hammond, at the time these experiments were run ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 161-162).

    For a decade, Krugman’s work went unquestioned by the scientific community. The New York University School of Medicine, New York State Department of Mental Hygiene, and the New York State Department of Public Health all approved the protocols for the various experiments. ("The Willowbrook Hepatitis Studies Revisited: Ethical Aspects”, 160) The first to truly question Krugman was Dr. Henry Beecher, an anesthesiologist and promoter of medical ethics. Beecher included Krugman’s study amongst many others he finds ethically dubious. He invoked a resolution adopted by the World Medical Association that states, “Under no circumstances is a doctor permitted to do anything which would weaken the physical or mental resistance of a human being except from strictly therapeutic or prophylactic indications imposed in the interest of the patient” (Beecher, 1359). Beecher argued that a physician should never intentionally harm a patient, mentally or physically, unless that action had the overall intention of benefiting the patient in the long term. Something like chemotherapy, which induces severe side effects, would be ethical to give to patients as it is a therapy for cancer. Beecher viewed it problematic to induce illness in others, even if it meant benefiting many more.

When developing the hepatitis B vaccine in the late 1970’s, Krugman tested that vaccine on chimpanzees (Gruber). Why then, could he not have done such experiments on chimpanzees from the start in order to observe hepatitis conditions? In that same letter, a Lancet editor agrees with these criticisms. The editor writes, “Dr. Golby asks The Lancet a question it ought to have faced long ago. The journal’s eagerness to discuss all the events in the elucidation of the spread of hepatitis left it exposed to these criticisms, which we accept” (Goldby, 749). All the criticisms share a common theme, the emphasis on the patient. They all portray the idea of experimentation, especially on children, in a negative light because to them experimentation is not a physician’s duty. To his critics, Krugman’s work should have focused on preventing and treating the hepatitis already present in the institution.  

In Krugman’s defense, it does seem that he genuinely thought he had the best interests of the children within his ward at hand. Krugman put in place an extensive informed consent plan and parents seemed to fully understand the experiments. A telegram from Israel Epstein, the President of the Benevolent Society for Retarded Children, stated: “The parents of the children who reside at the Willowbrook State School do not feel that their children are human guinea pigs. We are proud that our children can be an important part of society by helping in the research to develop much needed vaccines to eliminate infectious diseases” (Telegram from Mrs. Israel Epstein to Gabe Pressman). Parents did not seem to take issue with the experiments, so should medical ethicists take issue? William A. Fraenkel, the President of the Association for the Help of Retarded Children received a personal tour of the hepatitis unit at Willowbrook and came away impressed. In a letter to Jack Hammond, the director of the Willowbrook State School, Fraenkel said the children received “individual care, love, and attention”. He believed the protests against Krugman were unfair and hoped they will stop (Letter from Dr. William A. Fraenkel to Dr. Jack Hammond). When asked by another physician to introduce another strain of hepatitis in another study, Krugman refused on the basis that he only chose to do his experiments at Willowbrook because it was a very mild strain and children would be virtually guaranteed to be exposed to it upon entry (Letter from Dr. Saul Krugman to Dr. Robert Campbell). Even some of Krugman’s biggest critics applauded him after finding out more about his research. Upon discovering that Krugman had developed a boiled hepatitis B vaccine, Senator Thaler, who opposed his work vehemently, claimed the research had been done well (Immunization is Reported in Serum Hepatitis Tests).

Krugman was correct in saying hepatitis itself is usually a mild disease in children, but the fact remains that he continuously exposed an incredibly disadvantaged population to the possible symptoms of hepatitis, including fever, nausea, vomiting, and more. The very nature of the experiment, in which infected fecal matter was collected and then fed to children to induce the disease, sounds concerning (Letter from Dr. Saul Krugman to Dr. Harold H. Berman). The children received adequate care, certainly compared to what Willowbrook could offer within the confines of the general population, but does that validate Krugman’s decision? Hepatitis is caused by a microscopic virus, but at Willowbrook, what allowed its spread was the condition of the school itself. Eventually the school was closed down, but Krugman never seemed to have any interest in advocating for the rights of these children by pushing forward reforms to the school itself. His position is a tricky one, however. Is it the role of a physician to undertake such an endeavor? To Krugman, it was not his place. He was at Willowbrook to further the treatment of infectious diseases as a whole, which he accomplished.

The Willowbrook State School experiments will continue to be hotly debated, and it’s clear to see why. Unlike some other studies, like the Tuskegee syphilis experiment, Krugman’s work is not as clearly morally reprehensible. However, a study likely could not be performed today however, and I believe that says something about where medicine has shifted. The focus, after so many long years of experimentation and radical procedures, seems to have shifted back to be patient-centric. Medical ethics courses are taught in medical schools, institutional review boards are stricter, and patients expect more personalized care from their doctors. Overall, Krugman’s work was undoubtedly beneficial for future generations, but it is clear that he could have done so much more for the children at the school.

Works Cited

Beecher, Henry K. "Ethics and Clinical Research." New England Journal of Medicine 274.24    (1966): 1354-360. Web.

Goldby, Stephen. "Experiments At The Willowbrook State School." The Lancet 297.7702        (1971): 749. Web.

Gruber, Jack. Dental News, 1982; [Saul Krugman Papers]; The Lillian and Clarence de La    Chapelle Medical Archives, NYU Health Sciences Library.

Immunization is Reported in Serum Hepatitis Tests, 1971; [Saul Krugman Papers]; The Lillian    and Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

Krugman, S. "Viral Hepatitis. New Light on an Old Disease." JAMA: The Journal of the    American Medical Association 212.6 (1970): 1019-029. Web.

---. "The Willowbrook Hepatitis Studies Revisited: Ethical Aspects." Clinical Infectious    Diseases 8.1 (1986): 157-62. Web.

Letter from Dr. Jack Hammond to Miss Muriel McInerney, 1967; [Saul Krugman Papers]; The    Lillian and Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

Letter from Dr. Saul Krugman to Dr. Harold H. Berman, 1957; [Saul Krugman Papers]; The    Lillian and Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

Letter from Dr. Saul Krugman to Dr. Robert Campbell, 1961; [Saul Krugman Papers]; The    Lillian and Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

Letter from Dr. William A. Fraenkel to Dr. Jack Hammond, 1967; [Saul Krugman Papers];    The Lillian and Clarence de La Chapelle Medical Archives, NYU Health Sciences    Library.

MD Hits Back at Thaler Over Retarded Children, 1967; [Saul Krugman Papers]; The Lillian and    Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

Morrow, Bob. Human Experimentation; [Saul Krugman Papers]; The Lillian and Clarence de La    Chapelle Medical Archives, NYU Health Sciences Library.

Offit, Paul A. Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases.    Washington, D.C.: Smithsonian, 2007. Print.

Rothman, David J., and Sheila M. Rothman. The Willowbrook Wars. New York: Harper & Row,    1984. Print.

Saul Krugman—Awards; [Saul Krugman Papers]; The Lillian and Clarence de La Chapelle    Medical Archives, NYU Health Sciences Library.

The NYU Physician, 1982; [Saul Krugman Papers]; The Lillian and Clarence de La Chapelle    Medical Archives, NYU Health Sciences Library.

Telegram from Mrs. Israel Epstein to Gabe Pressman, 1967; [Saul Krugman Papers]; The    Lillian    and Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

The Willowbrook Experiments: Medical Fascism; [Saul Krugman Papers]; The Lillian and    Clarence de La Chapelle Medical Archives, NYU Health Sciences Library.

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