Tuskegee's Truths

Rethinking the Tuskegee Syphilis Study

Susan M. Reverby, Susan M. Reverby

• Éditeur: The University of North Carolina Press
• Année: 2012
• ISBN:
  9781469608723
• Sujet: Medicina
• Sous-sujet: Ética en medicina

Between 1932 and 1972, approximately six hundred African American men in Alabama served as unwitting guinea pigs in what is now considered one of the worst examples of arrogance, racism, and duplicity in American medical research--the Tuskegee syphilis study. Told they were being treated for "bad blood, " the nearly four hundred men with late-stage syphilis and two hundred disease-free men who served as controls were kept away from appropriate treatment and plied instead with placebos, nursing visits, and the promise of decent burials. Despite the publication of more than a dozen reports in respected medical and public health journals, the study continued for forty years, until extensive media coverage finally brought the experiment to wider public knowledge and forced its end. This edited volume gathers articles, contemporary newspaper accounts, selections from reports and letters, reconsiderations of the study by many of its principal actors, and works of fiction, drama, and poetry to tell the Tuskegee story as never before. Together, these pieces illuminate the ethical issues at play from a remarkable breadth of perspectives and offer an unparalleled look at how the study has been understood over time.

Part i: Overview

Racism and Research

The Case of the Tuskegee Syphilis Experiment

Allan M. Brandt

In 1932 the U.S. Public Health Service (USPHS) initiated an experiment in Macon County, Alabama, to determine the natural course of untreated, latent syphilis in black males. The test comprised 400 syphilitic men, as well as 200 uninfected men who served as controls. The first published report of the study appeared in 1936 with subsequent papers issued every four to six years, through the 1960s. When penicillin became widely available by the early 1950s as the preferred treatment for syphilis, the men did not receive therapy. In fact on several occasions, the USPHS actually sought to prevent treatment. Moreover, a committee at the federally operated Center for Disease Control decided in 1969 that the study should be continued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education and Welfare halt the experiment. At that time 74 of the test subjects were still alive; at least 28, but perhaps more than 100, had died directly from advanced syphilitic lesions.¹ In August 1972, HEW appointed an investigatory panel which issued a report the following year. The panel found the study to have been “ethically unjustified,” and argued that penicillin should have been provided to the men.²

This article attempts to place the Tuskegee Study in a historical context and to assess its ethical implications. Despite the media attention which the study received, the HEWFinal Report, and the criticism expressed by several professional organizations, the experiment has been largely misunderstood. The most basic questions of how the study was undertaken in the first place and why it continued for 40 years were never addressed by the HEW investigation. Moreover, the panel misconstrued the nature of the experiment, failing to consult important documents available at the National Archives which bear significantly on its ethical assessment. Only by examining the specific ways in which values are engaged in scientific research can the study be understood.

Allan M. Brandt is the Amalie Moses Kass Professor of the History of Medicine and Science at Harvard University and Harvard Medical School.

Originally published in The Hastings Center Report 8 (December 1978): 21–29. Reprinted by permission of the Hastings Center and Allan M. Brandt.

Racism and Medical Opinion

A brief review of the prevailing scientific thought regarding race and heredity in the early 20th century is fundamental for an understanding of the Tuskegee Study. By the turn of the century, Darwinism had provided a new rationale for American racism.³ Essentially primitive peoples, it was argued, could not be assimilated into a complex, white civilization. Scientists speculated that in the struggle for survival the Negro in America was doomed. Particularly prone to disease, vice, and crime, black Americans could not be helped by education or philanthropy. Social Darwinism analyzed census data to predict the virtual extinction of the Negro in the 20th century, for they believed the Negro race in America was in the throes of a degenerative evolutionary process.⁴

The medical profession supported these findings of late 19th- and early 20th-century anthropologists, ethnologists, and biologists. Physicians studying the effects of emancipation on health concluded almost universally that freedom had caused the mental, moral, and physical deterioration of the black population.⁵ They substantiated this argument by citing examples in the comparative anatomy of the black and white races. As Dr. W. T. English wrote: “A careful inspection reveals the body of the negro a mass of minor defects and imperfections from the crown of the head to the soles of the feet.”⁶ Cranial structures, wide nasal apertures, receding chins, projecting jaws, all typed the Negro as the lowest species in the Darwinian hierarchy.⁷

Interest in racial differences centered on the sexual nature of blacks. The Negro, doctors explained, possessed an excessive sexual desire, which threatened the very foundations of white society. As one physician noted in the Journal of the American Medical Association, “The negro springs from a southern race, and as such his sexual appetite is strong; all of his environments stimulate this appetite, and as a general rule his emotional type of religion certainly does not decrease it.”⁸ Doctors reported a complete lack of morality on the part of blacks:

Virtue in the negro race is like angels’ visits—few and far between. In a practice of sixteen years I have never examined a virgin negro over fourteen years of age.⁹

A particularly ominous feature of this overzealous sexuality, doctors argued, was the black males’ desire for white women. “A perversion from which most races are exempt,” wrote Dr. English, “prompts the negro’s inclination towards white women, whereas other races incline towards females of their own.”¹⁰ Though English estimated the “gray matter of the negro brain” to be at least 1,000 years behind that of the white races, his genital organs were overdeveloped. As Dr. William Lee Howard noted:

The attacks on defenseless white women are evidences of racial instincts that are about as amenable to ethical culture as is the inherent odor of the race.… When education will reduce the size of the negro’s penis as well as bring about the sensitiveness of the terminal fibers which exist in the Caucasian, then will it also be able to prevent the African’s birthright to sexual madness and excess.¹¹

One southern medical journal proposed “Castration Instead of Lynching,” as retribution for black sexual crimes. “An impressive trial by a ghost-like kuklux klan [sic] and a ‘ghost’ physician or surgeon to perform the operation would make it an event the ‘patient’ would never forget,” noted the editorial.¹²

According to these physicians, lust and immorality, unstable families, and reversion to barbaric tendencies made blacks especially prone to venereal diseases. One doctor estimated that over 50 percent of all Negroes over the age of 25 were syphilitic.¹³ Virtually free of disease as slaves, they were now overwhelmed by it, according to informed medical opinion. Moreover, doctors believed that treatment for venereal disease among blacks was impossible, particularly because in its latent stage the symptoms of syphilis become quiescent. As Dr. Thomas W. Murrell wrote:

They come for treatment at the beginning and at the end. When there are visible manifestations or when harried by pain, they readily come, for as a race they are not averse to physic; but tell them not, though they look well and feel well, that they are still diseased. Here ignorance rates science a fool.¹⁴

Even the best-educated black, according to Murrell, could not be convinced to seek treatment for syphilis.¹⁵ Venereal disease, according to some doctors, threatened the future of the race. The medical profession attributed the low birth rate among blacks to the high prevalence of venereal disease which caused stillbirths and miscarriages. Moreover, the high rates of syphilis were thought to lead to increased insanity and crime. One doctor writing at the turn of the century estimated that the number of insane Negroes had increased 13-fold since the end of the Civil War.¹⁶ Dr. Murrell’s conclusion echoed the most informed anthropological and ethnological data:

So the scourge sweeps among them. Those that are treated are only half cured, and the effort to assimilate a complex civilization driving their diseased minds until the results are criminal records. Perhaps here, in conjunction with tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.¹⁷

This particular configuration of ideas formed the core of medical opinion concerning blacks, sex, and disease in the early 20th century. Doctors generally discounted socioeconomic explanations of the state of black health, arguing that better medical care could not alter the evolutionary scheme.¹⁸ These assumptions provide the backdrop for examining the Tuskegee Syphilis Study.

The Origins of the Experiment

In 1929, under a grant from the Julius Rosenwald Fund, the USPHS conducted studies in the rural South to determine the prevalence of syphilis among blacks and explore the possibilities for mass treatments. The USPHS found Macon County, Alabama, in which the town of Tuskegee is located, to have the highest syphilis rate of the six counties surveyed. The Rosenwald Study concluded that mass treatment could be successfully implemented among rural blacks.¹⁹ Although it is doubtful that the necessary funds would have been allocated even in the best economic conditions, after the economy collapsed in 1929, the findings were ignored. It is, however, ironic that the Tuskegee Study came to be based on findings of the Rosenwald Study that demonstrated the possibilities of mass treatment.

Three years later, in 1932, Dr. Taliaferro Clark, chief of the USPHS Venereal Disease Division and author of the Rosenwald Study report, decided that conditions in Macon County merited renewed attention. Clark believed the high prevalence of syphilis offered an “unusual opportunity” for observation. From its inception, the USPHS regarded the Tuskegee Study as a classic “study in nature,”* rather than an experiment.²⁰ As long as syphilis was so prevalent in Macon ...