Book summary “Acres of skin”: summary

Introduction

You rarely consider how the pursuit of medical progress treats vulnerable human subjects as raw materials. You live in a society that trusts institutional science, yet history reveals dark chapters where human bodies served corporate profit and military ambition behind closed walls. Allen M. Hornblum exposes this disturbing reality in Acres of Skin. You discover how prisons once functioned as vast human laboratories for dermatological, pharmaceutical, and chemical experimentation.

The author investigates decades of secret, exploitative medical tests on inmates at Holmesburg Prison. You learn how university researchers, pharmaceutical giants, and federal agencies collaborated to bypass basic ethical standards.

The book answers critical questions about this hidden history:

• How did a major prison transform into a lucrative testing ground?
• What drove desperate inmates to subject their bodies to toxic hazards?
• Why did medical and political institutions ignore obvious human rights abuses for years?

1. The Fertile Field of Holmesburg Prison

Dr. Albert M. Kligman viewed the massive inmate population at Holmesburg Prison as an untapped human laboratory for dermatological and pharmaceutical research.

Origins of the Experiments

In 1951, a prison pharmacist invited Dr. Albert Kligman to consult on a severe athlete's foot outbreak. When you examine his response, you find a researcher surveying an ideal captive population. Kligman surveyed the inmates and famously remarked that he saw acres of skin and a fertile field for research.

He established a massive human testing ground under complete control conditions without formal contracts. Kligman began visiting Holmesburg regularly without formal authorization from the city or university. He relied on successive prison superintendents like Frederick S. Baldi and Edward J. Hendrick. There were approximately 1,200 prisoners at Holmesburg when Kligman first visited.

The Pharmaceutical Industry and Prisons

FDA regulations required new drugs to pass through animal tests before entering Phase I trials on healthy individuals to assess metabolic effects. Because prisoners were cheap, confined, and under total control, they constituted nearly 100 percent of Phase I testing populations across the country. Researchers like Kligman and Dr. Milton Cahn managed these lucrative operations.

Pharmaceutical houses such as Pfizer, Hoffman-LaRoche, Parke-Davis, Abbott, Lederle, and Smith, Kline & French hired independent researchers. They tested tranquilizers, sleeping pills, and antibiotics on inmates in designated cell blocks. The Holmesburg research program conducted 193 studies between 1962 and 1966. These trials used 153 experimental drugs, including 26 drugs awaiting marketing permission.

Inmates at Holmesburg were subjected to a wide variety of tests ranging from commercial cosmetics and household goods to dangerous dermatological, radiological, and military chemical agents. Mundane commercial items like toothpaste, deodorants, detergents, and shampoos formed the baseline of the program. Researchers also tested radioactive isotopes, dioxin, toxic vapors, mind-altering drugs, and potent viruses by inoculating prisoners with warts, herpes simplex, ringworm, and staphylococcus aureus.

In 1958, Kligman inoculated scores of healthy male volunteers with ectodermotropic viruses. He performed 47 inoculations across seven subjects on various skin areas including the penis, scalp, and face. A later 1961 study administered 1,000 inoculations to 150 subjects involving cutaneous moniliasis.

Prisoners volunteered for medical experiments primarily for financial compensation and relief from institutional boredom, despite receiving wages well below outside market rates. Inmates earned small sums for blood studies, biopsies, and participating in trials. This provided vital cash for commissary items, legal representation, and family support. Researchers and administrators defended the payments as an economic benefit that reduced prison riots by alleviating monotony.

Inmates earned standard wages such as $5 to $10 for blood studies or biopsies. Total annual inmate earnings from Penn research jumped from $73,253 in 1959 to $166,000 in 1961. During the first six months of 1966, researchers placed $115,000 into the pockets of prisoners.

2. Types of Experiments and Inmate Motivations

Inmates volunteered for hazardous medical tests purely for financial reasons and relief from institutional boredom, enduring severe physical damage without informed consent.

Ordinary prison wages sat at 15 cents a day for shop work. University research tests offered up to hundreds of dollars a month instead. You could buy commissary items or raise money for bail with that cash.

Inmate Al Zabala made between $300 and $400 a month juggling multiple tests. Withers Ponton made around $2,000 across 50 tests during 40 months in jail.

Patch Tests and Milkshakes

Cosmetic and pharmaceutical patch tests exposed your back and forearms to chemical substances and sunlamps. These applications caused severe blistering and permanent scars. You sat while researchers applied tests to your skin.

• Fix a grid made from thick strips of white hospital tape to the upper portion of an inmate's back shoulders containing about 20 squares.
• Apply a dab of lotion in each square.
• Expose the inmate's back to different temperatures from a sunlamp for 15 to 30 minutes.
• Cover the grid with a large solid piece of tape to prevent tampering.
• Inspect each square daily for blistering or adverse reactions over a 30-day period.

William Robb described patch tests where skin burned brown, itched, and blistered. The tests left inmates looking like zebras or checkerboards with skin discolorations.

Liquid diet studies required inmates to consume specialized nutritional drinks for extended periods. You could observe weight changes while avoiding the dangerous prison mess hall.

• Distribute vanilla-flavored milkshakes to thinner inmates and chocolate-flavored milkshakes to heavier inmates daily.
• Monitor weight changes and physical reactions over a testing period lasting 30 to 90 days.

William Robb successfully completed the milkshake test to stay out of the mess hall fights. Ron Keenan experienced horrible stomach cramps and supplemented his diet with contraband commissary sandwiches.

The U.S. Army also conducted secret mind-control and chemical agent tests on inmates inside specialized trailers. These trailers stood directly inside the prison yard.

Al Zabala was given an injection ten times stronger than LSD. He experienced a seven-day trip filled with childhood memories and remained subdued and unable to swallow solid food for a month afterward.

Lack of Informed Consent

Inherent power dynamics, widespread functional illiteracy, and deliberate deception by researchers ensured that inmates never gave true informed consent.

Prisoners were never told the specific chemicals, ingredients, or potential long-term toxic risks of the substances applied to or ingested by their bodies. Many inmates possessed a third-grade reading level. They signed waivers that even medical students could not fully comprehend.

Roy Williams participated in a dandruff shampoo test that made his hair fall out in large clumps. He threatened medical student Sigmund Weitzman in anger over the unexpected hair loss.

3. Military and CIA Chemical Warfare Programs

During the Cold War, the U.S. Army heavily researched psychochemicals and incapacitating agents to temporarily disable enemies without permanent injury. Seeking alternatives to lethal World War I gases, the Chemical Corps focused on deliriants and anticholinergics that affect the central nervous system. Because Edgewood Arsenal lacked sufficient facilities, the Army contracted the University of Pennsylvania to utilize Holmesburg Prison inmates.

The U.S. Army and the CIA partnered with the University of Pennsylvania to test potent psychochemicals, incapacitating agents, and skin-hardening irritants on inmates.

More than 7,000 military volunteers took part in Edgewood Arsenal drug tests. Over 1,000 civilians participated in similar studies at universities and hospitals.

Search for Incapacitating Agents

Following accidental exposures of two researchers to EA 3167 that resulted in prolonged delirium, the Army needed extended observation capacities. In 1964, they awarded contracts to the University of Pennsylvania to test 16 chemical agents on Holmesburg inmates, measuring cognitive performance and physiological responses. The University of Pennsylvania received six separate contracts totaling $650,000, plus $126,000 to Kligman's private lab Ivy Research. The unprecedented March 1964 contract involving prison inmates totaled $326,840.

The CIA joined forces with the Army under Project OFTEN to screen thousands of chemical compounds for behavioral control and interrogation. The agency utilized Holmesburg Prison and Edgewood Arsenal to test novel chemical agents like EA 3167 and EA 926. The initial screening involved 50 newly synthesized, novel compounds with promising behavioral activity, while a backlog of over 26,000 compounds still existed by 1971. On February 17, 1971, the CIA transferred $37,000 to Edgewood to extend research on the oral and trans-dermal routes of EA 3167.

Inmate Johnnie Williams volunteered for patch tests, cosmetics, microwave burns, and Army psychochemical trials in the prison yard trailers. He paid his bail using $700 to $800 earned from his first Army test, which required $500 cash under Philadelphia's 10 percent system. Johnnie Williams recalled that after being injected with an Army test substance in the trailers, he experienced vivid hallucinations and tore a toilet bowl off the hinges.

Project OFTEN and Skin Hardening

Dr. Kligman conducted extensive research for the U.S. Army on skin-hardening and accommodation processes using harsh, destructive chemical irritants applied to inmates. Kligman and Copelan tested occlusive patch tests, surface painting on foreheads, and arm immersions using toxic substances like 15 percent croton oil in equal parts of acetone and ethylene glycol monomethyl ether, 10 percent phenol in water, and 30 percent zinc chloride. They concluded that solid hardening required passing through an intense inflammatory phase with swelling, crusting, and scaling over a period of weeks.

You can review the specific application method recorded in the research:

• Apply patches for 1 to 4 hours on a daily basis using chemical concentrations that produce a maximum inflammatory reaction in about 10 to 14 days to achieve skin accommodation in six to eight weeks.

Pure, undiluted ethylene glycol monomethyl ether caused three test subjects to suffer psychotic reactions including hallucinations and stupor within two weeks, requiring hospitalization. Inmates subjected to mind-altering drugs in the trailers experienced grogginess, double vision, and terrifying hallucinations. Subjects administered Agent 668 reported that cracks or spots on the wall appeared to be faces or insects, and that the walls seemed to be breathing after one or two hours.

4. Radioactive Isotopes and Dioxin Trials

Federal agencies and chemical companies utilized Holmesburg inmates for dangerous radioactive isotope studies and high-dose toxic dioxin experiments.

Dr. Albert Kligman sought and acquired a By-Product Material License from the Atomic Energy Commission to conduct radioisotope experiments on the skin of Holmesburg Prison inmates. Kligman submitted applications to perform pharmacological studies on skin absorption using various radioactive isotopes, relying on a controlled prison environment that functioned like a gold mine for human experimentation.

Kligman applied for a license specifying isotopes such as:

• Carbon 14
• Mercury 203
• Nickel 63
• Arsenic 74
• Zirconium 95
• Sulfur 35
• Iodine 131
• Hydrogen 3

The Atomic Energy Commission's Medical Advisory Committee rejected specific radioactive isotopes proposed by Kligman due to severe health and genetic hazards. Panel reviewers raised alarms that injected isotopes like tritiated thymidine could reach the genetic DNA pool or cause unquantifiable cellular damage, forcing Kligman to drop certain substances from his protocols.

Four of seven reviewers disapproved the use of thymidine, with Dr. R.W. Rawson flatly disapproving its use in prisoner experiments. In May 1966, the AEC granted Kligman an amended materials license limited to Carbon 14 and Sulfur for his prisoner subjects.

Dioxin and Protocol Violations

Dow Chemical contracted Dr. Albert Kligman to test the toxic chemical TCDD on human subjects at Holmesburg Prison to establish a threshold for chloracne after outbreaks occurred at their manufacturing plant. Following chloracne outbreaks among plant workers in Midland, Michigan, Dow official Verald Keith Rowe contacted Dr. Kligman to determine human skin sensitivity compared to rabbit-ear bioassays. Kligman agreed to test the substance and provided liability waivers absolving Dow of responsibility.

Verald Keith Rowe testified before the EPA in November 1980, detailing how Dow supplied TCDD and recommended a conservative, gradual escalation protocol starting at 0.2 micrograms. Dow paid Dr. Kligman $10,000 for his research services after 49 workers developed chloracne in 1964.

Dr. Kligman drastically altered Dow's safety protocols by increasing the dioxin dosage hundreds of times without corporate notification, resulting in severe and prolonged lesions. After initial negative results using low doses, Kligman assembled a new panel of subjects and applied a much higher concentration repeatedly over a month. This unauthorized escalation resulted in severe inflammatory pustules and papules that lasted for months without active treatment to speed healing.

Kligman increased the total dosage administered to ten prisoners to 7,500 micrograms, which was an increase of 468 times what Dow had intended. This reckless action caused Dow to sever its relationship with him.

Public revelation of secret dioxin experiments at Holmesburg Prison emerged in early 1981 via investigative reporting and trade magazine articles, sparking widespread concern among former inmates. Inmates like Al Zabala learned for the first time through Corrections magazine and Philadelphia Inquirer articles on January 11, 1981, that they had been exposed to a dangerous chemical during the mid-1960s.

Al Zabala read the April 1981 issue of Corrections magazine, recognized he was a subject of the tests, and contacted the EPA, helping bring nearly six dozen inmates purposely exposed to TCDD into public view.

5. Institutional Complicity and the End of Testing

Lucrative financial incentives, academic prestige, and administrative indifference sustained the human testing enterprise until public exposés and legal battles forced its shutdown.

The 1966 FDA Crisis and University Complicity

In July 1966, the FDA suspended Dr. Kligman from testing investigational drugs following an investigation that uncovered severe record-keeping irregularities, falsifications, and protocol deviations. Triggered by a high volume of studies and a prominent journal article on the controversial universal solvent DMSO, FDA investigators discovered that studies were prematurely ended, adverse reactions were unreported, and records were missing or falsified. On July 19, 1966, the agency notified 33 drug firms that Kligman was ineligible to receive investigational drugs.

The Philadelphia Sunday Bulletin published a story in mid-summer 1966 announcing that Holmesburg's research facility was in doubt and drug tests were banned, forcing 75 percent of the prison's test projects to be abruptly dropped.

Dr. Kligman was reinstated by the FDA less than a month after his suspension, largely due to intense pressure and lobbying from high-ranking university and medical officials. Influential figures such as Dr. Donald Pillsbury, former chairman of dermatology at Penn, and Dr. Luther Terry, vice president for medical affairs and former U.S. surgeon general, intervened with the FDA to preserve the university's reputation and rescue the valuable testing facility. On August 15, 1966, acting FDA commissioner W.B. Rankin lifted the restrictions after Kligman submitted 14 proposals alongside Dr. Herbert Copelan to tighten up program procedures.

Closure and Legal Fallout

The medical testing program at Holmesburg Prison was officially shut down in January 1974 after two decades of operation due to intense public scrutiny and political pressure. Philadelphia prison system Board of Trustees chairman Angelo Galeone abolished the research unit completely without a phasing-out period, despite administrator Sol McBride noting an annual volume of business of $600,000 for the testing enterprise and 8,000 individual payments made to inmates totaling $113,214 in 1973.

Sol McBride offered an emotional defense to reporters, highlighting that Ivy Research was forced to lay off 15 persons due to the closure.

The American Civil Liberties Union presented strict regulatory guidelines at state hearings, insisting that if human experimentation in prisons could not meet rigorous ethical standards, a complete moratorium must be enacted. Attorney David Rudovsky outlined minimum conditions required for any lawful experimentation:

• Ensure all consents obtained for experiments are fully informed.
• Verify that prospective volunteers are in proper physical and mental condition.
• Ban waiver forms and exculpatory language in consent documents.
• Require researchers to carry insurance providing total coverage for adverse effects or death.
• Pay prisoner-volunteers at a scale commensurate with free world volunteers.
• Prohibit promised reduced sentences or favorable parole consideration for participation.
• Enforce safeguards ensuring experiments do not threaten prisoner lives or safety.
• Prohibit release of participation records without signed prisoner consent.
• Establish an independent supervisory committee independent of authorities and researchers.
• Require research sponsors to pay reasonable access fees for the inmate population.
• Provide greater opportunities for prisoners to work and earn money.

10 Key Ideas

1. Dr. Albert M. Kligman viewed the massive inmate population at Holmesburg Prison as an untapped human laboratory for dermatological and pharmaceutical research.
2. Inmates volunteered for hazardous medical tests purely for financial reasons and relief from institutional boredom, enduring severe physical damage without informed consent.
3. Inherent power dynamics, widespread functional illiteracy, and deliberate deception by researchers ensured that inmates never gave true informed consent.
4. The U.S. Army and the CIA partnered with the University of Pennsylvania to test potent psychochemicals, incapacitating agents, and skin-hardening irritants on inmates.
5. Dr. Kligman conducted extensive research for the U.S. Army on skin-hardening and accommodation processes using harsh, destructive chemical irritants applied to inmates.
6. Federal agencies and chemical companies utilized Holmesburg inmates for dangerous radioactive isotope studies and high-dose toxic dioxin experiments.
7. Dr. Kligman drastically altered Dow's safety protocols by increasing the dioxin dosage hundreds of times without corporate notification, resulting in severe and prolonged lesions.
8. In July 1966, the FDA suspended Dr. Kligman from testing investigational drugs following an investigation that uncovered severe record-keeping irregularities, falsifications, and protocol deviations.
9. Dr. Kligman was reinstated by the FDA less than a month after his suspension, largely due to intense pressure and lobbying from high-ranking university and medical officials.
10. The medical testing program at Holmesburg Prison was officially shut down in January 1974 after two decades of operation due to intense public scrutiny and political pressure.