“The greatest good to the greatest number”: penicillin rationing on the American home front, 1940–1945

qualities, especially when we find ourselves caught in the soulless, pitiless existence Rapoport describes. Is he unfair? Even he gave the MGB the names of friends and colleagues (p. 120), though throughout the book he tells us the probable dire effects of doing so. Yet he also cites instances of men forgiving colleagues for their betrayal, acknowledging that they could not help it (pp. 210-11). And Rapoport understands that intimidation and torture inevitably create victims: Fresh from prison, I had strong feelings on the subject and was not sure I would be able to overlook this 'betrayal.' But then I had a change of heart. I realized that one cannot demand heroism from everybody. People's powers of resistance vary greatly from extreme tenacity to complete lack of physical courage. (p. 138) The issue is not one that we can ignore as being of interest only to historians. For the medical profession, a related area is the self-governance of the profession. Occasionally-frequently?-physicians fail to protect patients by identifying colleagues who behave unethically or dangerously by reason of addiction, incompetence, or other causes. Where does loyalty to one's colleagues end and patients' rights take over? It takes moral courage to recognize that place and to act upon the knowledge. Medical torture is a more heinous if less widespread problem. In Nazi Germany, medical torture achieved its worst manifestations in the concentration camps. The NSDAP perverted the medical profession and destroyed its ethical underpinnings soon after the Nazis came to power. Without the support of a body of ethical beliefs, the participation of at least a few doctors in such unethical and often murderous activities followed inevitably. Rapoport experienced torture of two banal though often effective types: enforced sleeplessness and the constant use of self-tightening handcuffs. Today, more refined methods are in favour. Increasingly, medical practitioners in the service of certain regimes sanction or administer torture. No twisting of the Hippocratic Oath or its analogues can justify the participation of physicians in such activities. Medical torture is well known to have gone on in the USSR; countries such as Chile and Lebanon and many others regularly use medical torture as part of their machinery of political control. (For a recent analysis see Gordon Thomas, Journey into madness: medical torture and the mind controllers, 1988.) How can we encourage medical practitioners to fight these types of ethical perversion? In these permissive times there are …