A History of the 'Unfortunate Experiment' at National Women's Hospital

Linda Bryder

• Publisher: Auckland University Press
• Year: 2009
• ISBN:
  9781869404963
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference
• Edition: 1

In the late 1980s, a national outcry followed the publication of Sandra Coney and Phillida Bunkle's 'Unfortunate Experiment' article in Metro magazine about the treatment of carcinoma in situ at National Women's Hospital. The article prompted a commission of inquiry led by Judge Silvia Cartwright which indicted the practices of doctors at the hospital and led to lawsuits, censure, a national screening programme and a revolution in doctor–patient relations in New Zealand. In this carefully researched book, medical historian Dr Linda Bryder provides a detailed analysis of the treatment of carcinoma in situ at National Women's since the 1950s, an assessment of international medical practice and a history of the women's health movement. She tackles a number of key questions. Was treatment at National Women's an 'unfortunate experiment'? Was it out of line with international norms? Did Herb Green and his colleagues care more for science than for their patients? Did women die as a result? And what were the sources of the scandal that erupted?

1.

Introduction:
An Inquiry into Cervical Cancer

New Zealand’s National Women’s Hospital, situated in Auckland, was set up in 1946, a time when confidence in modern medical science soared throughout the Western world. Medical advances during the Second World War included the development of antibiotic drugs to combat serious infections, as well as blood transfusion and other improvements in surgical techniques which made major operations safer. It was confidently expected that further developments would follow. This was the golden age of medicine. Hospitals, with their modern equipment and laboratories, were associated in the public mind with heroic medical science, and medical practitioners and researchers enjoyed a higher social status than ever before.1 National Women’s Hospital, destined to become the largest women’s hospital in Australasia, was established as a result of massive fund-raising by women’s groups who sought to extend the benefits of modern biomedical science to women. Just over 40 years later this same hospital was the site of a huge public scandal and a government inquiry.2

In June 1987 Auckland’s Metro magazine published what has become a watershed in New Zealand’s medical history. The Journal of General Practice described it as a ‘bombshell’3 and the New Zealand Woman’s Weekly announced it had ‘opened what must be the most controversial and widely publicised can of worms in New Zealand medical history’.4 Another magazine, North and South, commented that the article was ‘one of the most influential pieces of investigative journalism ever published in this country’.5 Twenty-one years later the New Zealand Herald stated it had exposed ‘the biggest medical scandal of the century’.6

‘An Unfortunate Experiment at National Women’s’ was written by Sandra Coney, a journalist and feminist activist, and Phillida Bunkle, a senior lecturer in Women’s Studies at Victoria University of Wellington. They made a convincing case against Dr Herbert Green, associate professor of obstetrics and gynaecology at the University of Auckland Medical School, who they believed had caused a number of women to develop cervical cancer from carcinoma in situ (CIS) by withholding conventional treatment in order to study the natural history of the disease.7 The Metro article set the scene by citing a patient who compared National Women’s Hospital to Auschwitz in its medical experimentation.8

Coney explained in her prize-winning book published the following year:

A disastrous research programme had been carried out at National Women’s Hospital in Auckland and covered up for years. Women with pre-malignant abnormalities in the cells in the neck of the womb had not received conventional treatment for the condition. The statistician had calculated that these women had developed the maiming and potentially fatal invasive cervical cancer at an appalling twenty-five times the rate of women treated conventionally. They had had normal treatment withheld because one doctor, Associate Professor Herbert Green, believed that the abnormal cells were harmless. He argued that the pre-malignant disease, called carcinoma in situ or CIS, did not progress to invasive cervical cancer.9

The response to the magazine article was ‘instant and spectacular’.10 Within two weeks of its publication, the Minister of Health had set up an Inquiry headed by Silvia Cartwright (later Dame Silvia), a family and district court judge. The committee sat for six months, and submitted its report to the Minister in July 1988. Cartwright concluded that the medical profession had ‘failed in its basic duty to patients’.11

Upon the report’s publication, a local Labour MP, Richard Northey, referred to the 1947 Nuremberg Code on patient consent, which had arisen out of Nazi experiments on Jews and the mentally disabled, and declared that it was ‘absolutely atrocious that such ill-treatment should have occurred’ at National Women’s.12 Dr Alan Gray of the Cancer Society of New Zealand spoke of Green’s ‘total disregard for the long-term welfare of his patients’,13 and a leading article in the Australian Medical Journal stated, ‘If a similar treatment were proposed which involved animals, it no longer would be sanctioned by any hospital ethics committee in the world.’14 Another article in the New Zealand Nursing Journal by Jocelyn Keith, nurse tutor at the Victoria University of Wellington School of Nursing, entitled, ‘Bad Blood: Another Unfortunate Experiment’, compared Green’s research to the Tuskegee Syphilis Experiment in Alabama, USA, a study conducted between 1932 and 1972 on the effects of untreated syphilis, involving 600 black Americans. Keith wrote that long after this experiment had stopped, Cartwright ‘completed her inquiry into the allegations concerning the treatment of cervical cancer at National Women’s Hospital in Auckland’. It was, she said, ‘a damning indictment …. made even more damning when you realise that the unfortunate experiment at National Women’s was quietly proceeding while the Tuskegee Study and the Kennedy hearings were all over the world press.’15 The Nursing Journal described Green’s research as ‘a secret and life-threatening experiment on women’.16

A comment by Fertility Action, a feminist group headed by Sandra Coney which had given evidence to the Inquiry, was widely repeated in the press: ‘While the medical profession at National Women’s and elsewhere maintained closed ranks and an unbroken silence, the women continued to come to the hospital like lambs to the slaughter.’17 Not surprisingly then, a letter to the editor of a local paper following the report’s release declared, ‘New Zealanders owe an enormous debt to Sandra Coney, Phillida Bunkle, Sylvia [sic] Cartwright and those who helped create a climate to openly investigate medical wrong-doing. Never before have we been permitted to see such naked arrogance and contempt for women …. If indifference to the rights of people they profess to serve is not checked by lay people then doctors’ cavalier attitudes will continue to flourish.’18

I was in the United Kingdom when the 1987 Metro article appeared, working as a research fellow in the history of science at the Queen’s College in Oxford where I was resident from 1981 to 1988. A friend had given me a year’s subscription to Metro so I saw the article when it came out, and like everyone else was horrified by what had taken place in my home town. In mid–1988 I took up a lectureship in New Zealand history at the University of Auckland. My first major research project following my return to New Zealand was the history of the Royal New Zealand Plunket Society, a voluntary infant welfare organisation set up in 1907.19 As an extension of that and with a growing interest in the history of reproductive health, I then decided to research the history of National Women’s Hospital, a significant institution in New Zealand’s history and in the history of medicine. It was after all the site of important medical developments internationally through the work of Sir William Liley and Sir Graham Liggins. Liley had performed the first intrauterine blood transfusion in the world, a groundbreaking treatment for Rhesus haemolytic disease. Liggins had pioneered the administration of corticosteroids to women about to have premature babies; this prevented the babies’ lungs from collapsing upon birth, a treatment that was subsequently adopted internationally. National Women’s Hospital also lent itself to a study of the politics of childbirth. While my primary interest lay in the history of reproductive health, I knew that as part of the research into the hospital I would have to deal with the so-called ‘unfortunate experiment’ and the Cartwright Inquiry which emerged from it. My initial chapter outline envisaged that this would feature midway through the text as literally an unfortunate episode in the hospital’s history. Sandra Coney’s book, an amplification of the Metro article, would be the principal source, providing, as the cover promised, the ‘full story behind the Inquiry into Cervical Cancer Treatment’. In her report Cartwright commended the authors of the Metro article for their ‘extraordinary determination to find the truth’. She said that, ‘The factual basis for the article and its emphasis have proved to be correct.’20

While working on this project, I spent some months on sabbatical leave in Oxford. There I took advantage of the extensive run of medical journals and other publications at the Radcliffe Science Library to inform myself of the background into the medical condition that was the subject of the Inquiry – carcinoma in situ of the cervix. The literature I accessed there came as a surprise and forced me to revise my own view of the ‘unfortunate experiment’ and the Cartwright Inquiry. On returning to New Zealand, I followed this up with a careful reading of the Inquiry transcripts and the considerable media coverage. While 72 interviews conducted by Cartwright with patients remain closed files, what happened to these women can be gleaned from lawyer Rodney Harrison’s use of their case notes during his cross-examination of Green at the Inquiry, from Judge Cartwright’s report and from Sandra Coney’s book on the Inquiry. The transcripts of the eleven women who came forward to give evidence publicly, submissions to the Inquiry, and the many letters written to Cartwright, Health Minister Michael Bassett and medical superintendent Gabrielle Collison provide further evidence of patient experience. I quickly decided that the story which emerged merited a book in its own right, as it would threaten to overwhelm a general history of the hospital and its work in reproductive and neonatal health and medicine. In the early stages of researching the general hospital history, I had contracted Dr Jenny Carlyon to conduct interviews with many of those involved with the hospital. The mass of written material concerning the Cartwright Inquiry made it unnecessary to conduct further or more focused interviews. For this study I draw primarily on written records, both published and unpublished, which are extensive as well as extremely varied. Before embarking on the history, I knew very little about the dramatis personae in this story. The narrative which unfolded, written from the per...