In 1932, in the area surrounding Tuskegee, Macon County, Alabama, the United States Public Health Service (PHS) and the Rosenwald Foundation began a survey and small treatment program for African-Americans with syphilis. Within a few months, the deepening depression, the lack of funds from the foundation, and the large number of untreated cases provied the government’s reseachers with what seemed to be an unprecedented opportunity to study a seemingly almost “natural” experimentation of lantent syphilis in African-American men.
What had begun as a “treatment” program thus was converted by the PHS reasearchers, under the imprimatur of the Surgeon General and with knowledge and consent of the Prewsident of Tuskegee Institute, the medical director of the Institute’s John A. Andrew Hospital, and the Macon County public health officials, into a persecpective study-The Tuskegee Study of Untreated Syphilis in the Negro Male (Jones1-15). Moreover, the Tuskegee Syphilis Study, which began in 1932 and was terminated in 1972 by the protest of an enraged public, constituted the longest nontherapeutic experiment on human beings in medical history.
Since the premise on which the experiment was based did not involve finding a cure or providing treatment, the question then remains why did the study begin and why was it continued for four decades? In Bad Blood: The Tuskegee Syphhilis Experiment, James Jones describes the fate of the 600 Black victims. Ultimately, 399 men, who were in the late or tertiary stages of syphilis, participated in the experiment. In addition, 201 men who were free of the disease were in cluded in the study. Both groups of men were neither told the truth about their ailment or lack thereof, nor were they informed that they were part of a medical study.
Medical personnel assured the subjects that they were suffering from “bad blood,” a euphemism that in the local parlance, reffered to many ailments. None of the men knew that the “bad blood” which coursed through their veins was contagious. None understood how the disease was transmitted; no one explained to them that congenital syphilis was passed on from female to fetus. It was an experiment based on deception, a characteristic that it retained for the next forty years. Through a historical analysis of the xperiment several questions arise, particularly the issues of the men’s participation in the experiment and the black professionals who witnessed the study. Why did these Black men take part in this study? Why did the Black healtth professionals not challenge the study? The answers to these questions are interconnected and lies captive in a term Jones calls racial medicine (Jones 15). Prior to 1932 information concering the origin, conception, developement, and the complications of untreated syphilis was known to medical science. The one element left to be known about this diease was a cure.
By this time, scientist were well aware of the fact that syphilis was a highly contagious diease caused by treponema pallidum, a microscopic organism resembling a corkscrew. The disease may be acquired, meaning passed from person-to-person either during sexual intercourse or mixing of bodily fluids, or congenital meaning obtained through birth. The disease progresses in three stages: primary, secondary, and tertiary. The characteristics for the first two stages exhibit chancre sores, various mild rashes, bone and joint pain, as well as cardiac palpitations.
Following the secondary stage is a period of latency where all symptoms associated with syphilis disappear, a period that may last from a few weeks to thirty years. At this time, delusion of health is shattered and the symptoms revisit with a harsher intensity. It is at the tertiary stage that the majority of the damage is done. Tumors begin to coalesce on the skin forming huge ulcers covered with a crust of dried exuded matter. Bones are attacked by tumors and in some cases eaten entirely away. The tumors also attack the walls of the heart or blood vessels causing aneurysms, balloon like sacs filled with blood.
If the aneurysm burst, death is instantaneous. Syphilis can attack the brain in a condition known as paresis, in which the brain softens and produces paralyis and insanity. Optic nerves can be attacked causing blindness or inflicting deafness (Jones 2-4). The progression of th de disease in each stage had been known prior to 1932, the year the Tuskegee experiment began (Jones 2-4). In fact a similar study that observed the effect of untreated syphilis in man took place some forty years before Tuskegee in an experiment that took place n Olso, Norway (Jones 10). It is from this first study that much of the knowledge known about untreated syphilis previous to Tuskegee was uncovered. The difference, however, is that the men in Olso went untreated because there was no known treatment and in the case of Tuskegee treatment was deliberately withheld. In fact the discovery of the Salvaran treatment for syphilitic patients prompted the end to the Olso study in 1910. Racial differences create a plethora of opportunities through which a people can be labeled inferior.
Jones explains that physicians and scientist have always been fascinated by the “large number of ways in which blacks appeared to be different” (Jones 16). Thus, the question Jones’ presents of racial medicine becomes a more contingent issue for why the experiment began and continued for decades. Preceding this fascination or preoccupation with establishing differences between the races is a reason, one that Jones describes as: There was a compelling reason for this prepccupation with establishing physical and mental distinctions between the races, one that transcended the isinterested pursuit of empirical facts. Most physicians who wrote about blacks during the nineteenth century were southerns who believed in the existing social order. They justified slavery, and after its abolition, second-class citizenship by insisting that blacks ere incapable of assuming any higher station in life… here ‘different’ unquestionably meant ‘inferior. ’ Thus, medical discourses on the peculiarities of blacks offered, among other things, a psudoscientific rationale for keeping blacks in their places (Jones 17). Jones discusses the racial attitudes that help to sustain this study.
White physicians and scientist shared in the prevalent racism that saturated the United States especialy the South. Many of the white physicians involved were convinced that syphilis was a black disease and that it was more prevaleent among blacks then whites. Jones concludes, “whether by accident or design, physicians had come dangerously close to dipicting the syphilitic black as the represenative black” (Jones 28). To deny that race played a role in the Tuskegee study is naive. All 600 subjects (399 experimantals and 201 controls) were Black.
The officials in charge of the study failed to obtain informed consent from the subjects in a study of a disease with known risk to human life. little respect was shown to the subjects. The reseachers were not compelled to explain to the men whatexactly was occurring to them. The reasearchers were evidently never troubled by any ethical questions raised by the study of this nature. Denying the men salvarsan or mercury in the 1930’s, current treatments for syphilis during this time, or penicillin after is was discovered and identified as a cure for syphilis in the 1940’s.
By failing to obtain informed consent and offering incentives for participation, it is quite obvious that the PHS doctors were performing unethical annd immoral experiment on human subjects. From the moment the experiment begun, the immorality of the experiment was blatantly apparent. Instead of obtaining consent from the participants, the PHS offered the men incentives to participate: free physical examinations, free rides to and from the clinics, hot meals on examination days, free treatment for minor ailments, and a gurantee that a burial stipend would be paid to their survivors. This modest stipend of $50. 0 represented the only form of burial insurance that many men had (153). When the subjects were administered painful lumbar punctures in 1933 ( commonly known as a spinal tap where a needle is driven into one’s vertebrate and fluid is suctioned from the spinal cord, a procedure that exposed the patients paralysis or death) their cooperation was obtained under false pretenses. Dr. Vonderlehr, one of the leading reseachers in the study, wrote letters to each patient inviting him to a special experiment, adding that “remember this is your last chance for special free treatment” (Jones 127).
The physicians continued to conceal the truth that this procedure was diagnostic rather than therapeutic by telling the patients that they were receiving “spinal shots” (Jones 127). To understand why so many black men welcomed the opportunity of receiving what appeared to be free health care, though they received bad treatment, one must understand the social and economic conditions of rural Macon County, Alabama at the beginning of the twentieth century. The Census of 1930 revealed that blacks made up 82 percent of Macon’s twent-seven thousand residents.
Blacks outnumbered whites four to one and neraly half of the resisdents lived below poverty level. It was all to common to visit houses without indoor plumbing and no other means of water supply save a swallow well that occupied the same territory as that of sewage (Jones 61). The fifth chapter of Jones’s Bad Blood: The Tuskegge Syphillis Experiment entitled “The Dr. Ain’t Taking Sticks” describes the destitute environment in which Blacks lived: … housing conditions were terrible. The typical dwelling was a tumble-down shack ith a dirt floor, screens, little furinature, a few rags for bedding, and a privy only when underbrush was not nearby. Drinking water came from an uncovered, shallow well, often totally unprotected from direct surface drainage. The people who lived in his rural slum ate a pellagrous diet [of]… salt pork hominy grits, cornbread, and molasses formed the standared fare of the majority Macon County’s black residents, while red meat, fresh vegitables and fruit, or milk seldom appeared on their tables. As a result, chronic malnutrition and a host of diet-related illnesses were serious health problems (Jones 62).
Medical facilities were present, however, the treatment that each gave was limited. The United States Veterans hospital located on the campus of Tuskegge Institute did not have an outpatient clinic and did very little for the surrounding community. The intellectual aloofness found at the Veterns Hospital was similar at the John A. Andrews Hospital also located in the vicinity of Tuskeggee Insistute. The John A. Andrews Hospital did have an outpatient clinic but the impact that the hospital had on the community was not substantial (Jones 64).
It was the norm for many Blacks to go to from “cradle to the grave” without having experiencing any type of medical care (Jones 65). Since doctors were only consulted in dire emergencies, many blacks suffered with syphilis and its complications. So in 1930 when the Surgeon General announced that a syphilis control program was being created in Macon County blacks werein some cases excited about seeing a doctor and in other cases instructed by their employer to see a doctor without any explanation. Initially, the program was indeed a type of syphilis control program.
Later that year, however, it was recommended that the syphilis control program be terminated and plans for a comprehensive health and welfare program be instituted. In 1932, the United States Public Health Service officers returned to Tuskegee and converted the treatment program into a “nontherapeutic human experiment” (Jones 90). The goal of the progam now was to aquire as many autopsies as possible that will support the argument that people of African descent reacted differently to venereal diseases such as syphilis and that this disease in character was a black disease. Once the Tuskegee expiriment began it thrived from its own momentum.
The “intellectuals” who were aware of the study did not reject to it. The black professionals affiliated with Tyskegee institute at the time the experiment was taking place did not object either. The question remains why did Black healtth professionals not challenge the study? The information concerning the details of the experimnet was not at all private; the disclosure of information concerning Tuskegee seemed very calculated. In fact they appeared in many of the major health and medical journals of the time period,places were the average person may not ordinarily look. However, Black health professionls like Dr.
Paul B. Cornely of Howaed University,a black public health leader since the 1930’s knew about Tuskegee but did not object. He understood the nature of the study and followed it closely, never questioning it. He explained in retrospect: I was there and I didn’t say a word. I saw it as an academician. It shows you how we looked at human beings, especially blacks who were expendable… I have guilt feeling about it, as I veiw it now… because I considered myself to be an activist. I used to get hot and bothered about injustices and inequality, yet right under my nose something is happening and I’m blind (Smith 103).
Many Black professionals hide behind the suppositions that what was occuring at Tuskegee Institute would draw much needed attention to the desolate social, economic, and medical environments of the Black community. There is no doubt that the history of racial subjugation, class-consciousness, and professional status contributed to the response or lack thereof from black professionals and intellectuals. Historian Tom W. Shick argued that black medical professionals did not or could not challenge the experiment because they were not seen as equals in the medical profession, i. e. blacks did coexist with whites (Journal 103).
Jones states that class-consciousness permits black professionals to deny that the experimnet was racist. There existed a dilemma for the black professionals involved: “on the one hand scientific energy and money were to be devoted to the study of diseased blacks, long ignored by science and medicine; but, on the other hand, the whole notion of framing the experiment as a study of the ‘the diseased’ instead of ‘disease’ smacked racism. (Jones 167). In Bad Blood, Jones presents the questions of why these 600 black men participated in the study and why did Black professionals allowed this experiment to continue without any objections. t is quite evident that ultimately, the reasons why the Tuskegee Study of Untreated Syphilis in the Negro Male begun and continued was because of raism. Racism created the economic and social impecunious conditions of the 1930’s that would allow these men to accept their offer. racism created the conditions that would allow black people to “turn the other cheek” as their brothers were being victimized, exploited and murdered. Racism in this case and many other instances of historical racial oppression offered no alternatives.