Social and Historical Context

This resource for The Least of My Brothers is intended to provide a brief orientation to the historical, cultural, and social context of the PHS Syphilis Study at Tuskegee. A complete list of sources can be found at the end of this page. You can also select the date of any item to see its source; select the date on the source to return to the item.

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Prologue (1849-1926) | Episode One (1926-1932) | Episode Two (1932-1942) | Episode Three (1943-1974) | Epilogue (1975-1997) | Sources


Prologue (1849-1926)

1849 Worthington Hooker publishes Physician and Patient, the only comprehensive study of medical ethics by an American in the 19th century. In this work, Hooker champions the patient's right to information and denounces a physician's practice of deception. This idea drastically contradicted the prevailing view in medicine, endorsed by the AMA 1847 "Code of Medical Ethics," that deception is morally acceptable when the physician deems it to be in the best interest of the patient.
1865 The Ku Klux Klan (KKK), a secret and violent white-supremacist organization, is founded by veterans of the Confederate Army. It is disbanded by 1880.
1870 The Social Hygiene Movement is launched in an attempt to combat prostitution, venereal diseases, and the double standard of sexual morality.
1871 Congress passes the Ku Klux Klan Act in an attempt to stop the illegal activities of the KKK and other Southern vigilante groups.
1873 The Comstock Act is enacted, prohibiting the US Postal Service to send "indecent" pictures, writings, and pornography. This law also applies to materials intended to educate the public about birth control and venereal disease.
1890 In an attempt to stop the Ghost Dance, US federal troops massacre 350 Lakota, many of them unarmed women and children, at Wounded Knee, South Dakota. This marks the last armed engagement of the so-called Indian Wars.
1896 In Plessey vs. Ferguson, the Supreme Court rules that "separate but equal" treatment of black Americans is constitutional.
1900 American Army surgeon Walter Reed conducts yellow-fever experiments in Cuba. These studies employ one of the first formal procedures of informed consent, requiring all volunteers to sign a written informed consent document. Subjects are given $100 US dollars for receiving the yellow-fever inoculation and are compensated with a $100 "supplement" if they contract yellow fever. The practice of obtaining informed consent to participate in research is not widely followed until the 1960s.
1901 105 documented lynchings of black Americans.
1906 Richard Clarke Cabot, Harvard physician and socio-medical ethicist, decries the widespread deceptive clinical practice of placebo-giving. Cabot argues it weakens the physician-patient relationship "because every placebo is a lie, and in the long run the lie is found out."
1908 Henry Ford introduces his Model T automobile.
1910 NAACP established.
1914 Social reformers look at venereal disease as one indicator of social conditions in America. Numerous "anti-venereal disease" groups work to improve medical and educational interventions in this public health area.
1914 Schloendorff v. New York Hospital establishes legal precedent for a patient's right of "self-determination" justifying an obligation to obtain consent for medical procedures. Numerous cases that follow are justified by this rationale, helping to establish a legal requirement for informed consent. Notably, cases cite Schloendorff v. New York Hospital as late as the 1950s and 1960s.
1915 The second Ku Klux Klan (KKK) is organized. This group, although preaching racism, is a mainstream organization with 4 million members at its peak in the 1920s - approximately one KKK member for every two African Americans in the US (black population, 1920 census: 10,463,131).
1916 Margaret Sanger opens a family planning clinic in Brooklyn. Authorities close the clinic shortly after its opening and arrest Sanger on charges of obscenity.
1917 United States enters World War I; more than 350,000 African Americans served in segregated units during the war.
1919 Black servicemen returning to the US from duty overseas are met frequently with hostility from whites. Of the 77 black Americans lynched this year, 10 are returned veterans. Race riots break out in numerous cities across the country as racial tensions escalate.
1920 First commercial radio broadcast, election day, via KDKA in Pittsburgh. People hear the results of the Harding-Cox presidential race before they read about it in the newspaper.
1920 The 19th Amendment gives women the right to vote.
1925 17 documented lynchings of black Americans.

Episode 1 (1926-1932)

1928 The Cooperative Clinical Group for the study of syphilis is formed. As the first major systematic studies on syphilis in the United States, it also marks a growing trend in American medical research -- the collaborative study.
1928 Alexander Fleming discovers penicillin; however, it is not widely used until Ernst Chain and Howard Florey develop a powder form of it in 1939.
1929 Stock Market crashes, Great Depression begins
1931 University of Michigan physician Dr. J. Burns Amberson conducts the first randomized controlled trials while studying the efficacy of treatments for pulmonary TB. Randomization is determined by a coin toss.

Episode 2 (1932-1942)

1933 President Franklin Delano Roosevelt institutes the New Deal.
1937 First National Social Hygiene Day celebrated.
1937 Surgeon General Thomas P. Parran publishes his book about syphilis, Shadow on the Land. It is well received by the public and the medical community.
1938 Child labor is made illegal through the Fair Labor Standards Act.
1938 Venereal Disease Control Act is passed, allocating funding for rapid treatment centers to provide the latest in VD treatment.
1940 5% of voting-age blacks are registered to vote.
1941 Japan attacks Pearl Harbor.
1942 The US government orders the internment of 110,000 Americans of Japanese descent.
1942 Women are allowed to serve in all branches of the Armed Forces in auxiliary or reserve units; the Marines open their recruitment to black men.
1942 American researchers begin clinical research to develop new drugs to treat venereal diseases. The lack of effective treatments and the importance of preventing the spread of disease among World War II soldiers justify this research. Over the next five years, a number of studies are conducted in prison populations to investigate the effectiveness of new drugs.

Episode 3 (1943-1974)

1943 Changes in social perception of venereal disease, brought about in part by the publication of Shadow on the Land (see 1937), cause a shift in focus from moral to medical interventions to address the problem of sexually-transmitted diseases.
1944 250 race riots break out in 47 US cities.
1945 The United States drops two atomic bombs on Japan.
1947 Major League baseball becomes integrated when Jackie Robinson joins the Brooklyn Dodgers.
1948 First double-blind randomized clinical trial conducted by Dr. Austin Bradford-Hill on streptomycin. This experiment marks the beginning of the era of the randomized clinical trial.
1948 First network newscast, CBS-TV news, debuts.
1948 Alfred Kinsey's Sexual Behavior in the Human Male is published amidst much controversy, creating the foundation for sex research in the United States. His even more controversial "female" volume follows five years later.
1948 Truman issues order to desegregate the armed forces.
1950 Korean War begins.
1950 McCarthy launches anticommunism campaign.
1954 Brown vs. Board of Education ruling declares segregation unconstitutional.
1955 Fourteen-year-old Emmett Till is lynched in Money, Mississippi for "insulting" a white woman, and his murderers are acquitted by an all-white jury. Jet magazine publishes photos of Till's body on its cover, partially igniting the sentiments that propelled the nation into the Civil Rights movement.
1955 Rosa Parks refuses to give up her seat to a white man on a bus, marking the beginning of the Montgomery, Alabama bus boycott and the start of the Civil Rights Movement.
1957 Salgo v. Leland Stanford Jr. University Board of Trustees first uses the term "informed consent". The court finds that securing consent is insufficient; physicians have a duty to inform patients about the risks and alternatives of treatment in addition to treatment procedures and their consequences.
1961 Donald Oken, a Chicago physician, publishes a study in the Journal of American Medical Association reporting that 9 of every 10 physicians do not disclose diagnoses of cancer to their patients. The physicians surveyed maintained that sustaining a patient's hope is more important than truth-telling.
1962 US Congress passes the "Drug Amendments of 1962" which outline the requirements for human subjects research involving drugs. This law sets the standard for "well-controlled investigations" in clinical research.
1963 Martin Luther King, Jr. gives his I Have a Dream speech during the March on Washington.
1963 President John F. Kennedy is assassinated.
1964 One documented lynching of a black American.
1964 The Civil Rights Act of 1964, which is the broadest and strongest civil rights legislation since reconstruction, puts a legal end to Jim Crow.
1965 Watts riots in Los Angeles: 34 dead, 1000+ injured.
1968 Martin Luther King Jr. is assassinated in Memphis.
1969 Neil Armstrong becomes the first human to walk on the moon.
1969 Massive anti-Vietnam War demonstration in DC.
1970 Food and Drug Administration clarifies the "Drug Amendments of 1962" by providing definitions for the "well-controlled" studies. This clarification states that such "studies must (ideally) incorporate a contemporaneous control group assigned at random and 'permit qualitative evaluation' of treatment effects using 'appropriate statistical methods'."
1974 Nixon resigns in the wake of the Watergate scandal.

Epilogue (1975-1997 )

1979 Religious conservatives found the Moral Majority and become a strong influence in American politics.
1982 Scientists use the term "AIDS" for the first time to refer to an observed high incidence rate of Kaposi's Sarcoma (an AIDS-related cancer) in otherwise healthy gay men in the United States.
1984 Jesse Jackson becomes the first African American to make a serious bid for the Presidency, receiving 3.3 million votes in the Democratic primaries.
1986 Martin Luther King Day established as a national holiday.
1991 Clarence Thomas becomes the second black to sit on the Supreme Court amidst highly publicized allegations of sexual harassment by law professor Anita Hill.
1992 After Los Angeles police officers are acquitted of the 1991 videotaped beating of motorist Rodney King, riots break out in L.A.
1992 Carol Mosely-Braun first African American woman elected to the US Senate.
1995 Former football star OJ Simpson is acquitted of killing his former wife and her friend in one of the most widely publicized and racially divisive trials of the century.
1996 63.5% of voting-age blacks are registered to vote.
1997 President Bill Clinton issues an official apology to the victims of the PHS Syphilis Study at Tuskegee.

Sources

1849 Worthington Hooker publishes Physician and Patient. Source: Beauchamp, Tom and Ruth Faden. A History of Informed Consent. New York: Oxford University Press, 1985.
1865 The first Ku Klux Klan (KKK) is organized. Source: "Ku Klux Klan." Wikipedia. http://en.wikipedia.org/wiki/Ku_klux_klan
1870 The Social Hygiene Movement is launched. Source: h. Jones, James H. 1993. Bad Blood: The Tuskegee Syphilis Experiment. New York: The Free Press.
1871 Congress passes the Ku Klux Klan Act . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1873 The Comstock Act is enacted. Source: Langley, Winston E., and Vivian C. Fox, eds. 1994. Women's Rights in the United States: A Documentary History. Westport, CT: Greenwood Press.
1890 Massacre at Wounded Knee. Source: "Events in the West: 1890-1900." PBS Online. © 2001 The West Film Project. http://www.pbs.org/weta/thewest/events/1890_1900.htm
1896 Plessey vs. Ferguson. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1900 Yellow-fever experiments in Cuba. Source: "The United States Army Yellow Fever Commission." University of Virginia Health Sciences Library Historical Collections. http://yellowfever.lib.virginia.edu/reed/commission.html#ic.
1901 105 documented lynchings of black Americans.. Source: "African American Perspectives: Timeline of African American History," American Memory Project, Library of Congress. http://lcweb2.loc.gov/ammem/aap/timelin3.html
1906 Richard Clarke Cabot decries placebo-giving . Source: "Richard Clark Cabot." http://www.whonamedit.com/doctor.cfm/1906.html.
1908 Model T automobile. Source: "Technology Timeline." The American Experience. 2001. PBS Online. http://www.pbs.org/wgbh/amex/telephone/timeline/index.html
1910 NAACP established. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1914 Social reformers focus on venereal disease. Source: American Social Health Association (ASHA), 2001. http://www.ashastd.org/aboutasha/history.html
1914 Schloendorff v. New York Hospital. Source: Beauchamp, Tom and Ruth Faden. A History of Informed Consent. New York: Oxford University Press, 1985.
1915 The second Ku Klux Klan (KKK) is organized. Source: "Ku Klux Klan." Wikipedia. http://en.wikipedia.org/wiki/Ku_klux_klan
1916 Margaret Sanger opens family planning clinic . Source: Langley, Winston E., and Vivian C. Fox, eds. 1994. Women's Rights in the United States: A Documentary History. Westport, CT: Greenwood Press.
1917 United States enters World War I. Source: "World War I and Postwar Society." African American Odyssey. http://memory.loc.gov/ammem/aaohtml/exhibit/aopart7.html
1919 Post-WWI race riots . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1920 First commercial radio broadcast . Source: "KDKA Begins to Broadcast: 1920." A Science Odyssey: People and Discoveries. PBS Online. © 1998. http://www.pbs.org/wgbh/aso/databank/entries/dm28pe.html
1925 17 documented lynchings of black Americans. Source: "African American Perspectives: Timeline of African American History," American Memory Project, Library of Congress. http://lcweb2.loc.gov/ammem/aap/timelin3.html
1928 Alexander Fleming discovers penicillin. . Source: "Alexander Fleming," A Science Odyssey: People and Discoveries. PBS Online. © 1998. http://www.pbs.org/wgbh/aso/databank/entries/bmflem.html
1928 The Cooperative Clinical Group for the study of syphilis is formed . Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1929 Great Depression begins. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1931 Dr. J. Burns Amberson conducts the first randomized controlled trials.. Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1933 New Deal. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1937 First National Social Hygiene Day celebrated.. Source: American Social Health Association (ASHA), 2001. http://www.ashastd.org/aboutasha/history.html
1937 Surgeon General Thomas P. Parran publishes Shadow on the Land. Source: Office of the Surgeon General. "Thomas P. Parran." http://www.surgeongeneral.gov./library/history/bioparran.htm
1938 Child labor is made illegal . Source: "Fair Labor Standards Act: What Does it Require?" US Department of Labor. http://www.dol.gov/elaws/esa/flsa/screen5.asp
1938 Venereal Disease Control Act . Source: American Social Health Association (ASHA), 2001. http://www.ashastd.org/aboutasha/history.html
1940 5% of blacks registered to vote. Source: Thernstrom, Stephen and Abigail Thernstrom. 1997. America in Black and White: One Nation, Indivisible. New York: Simon and Schuster.
1941 Japan attacks Pearl Harbor. Source: "Internment History," Children of the Camps. PBS Online. ©1999. http://www.pbs.org/childofcamp/history/timeline.html
1942 Internment of 110,000 Japanese Americans. Source: "Internment History," Children of the Camps. PBS Online. ©1999. http://www.pbs.org/childofcamp/history/timeline.html
1942 Armed Forces open their recruitment . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1942 Clinical research to develop new drugs to treat venereal diseases. Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1943 Changes in social perception of venereal disease . Source: American Social Health Association (ASHA), 2001. http://www.ashastd.org/aboutasha/history.html
1944 250 race riots in 47 US cities. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1945 US drops atomic bombs on Japan. Source: "Internment History," Children of the Camps. PBS Online. ©1999. http://www.pbs.org/childofcamp/history/timeline.html
1945 US drops atomic bombs on Japan. Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/
1947 Jackie Robinson joins the Brooklyn Dodgers. Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/
1948 Truman desegregates the armed forces. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1948 Alfred Kinsey's publications. Source: "Publications," The Kinsey Institute for the Study of Sex, Gender, and Reproduction. © 2002. http://kinseyinstitute.org/publications/
1948 First network newscast. Source: "Technology Timeline." The American Experience. 2001. PBS Online. http://www.pbs.org/wgbh/amex/telephone/timeline/index.html
1948 First double-blind randomized clinical trial conducted by Dr. Austin Bradford-Hill . Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1950 Korean War begins. Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/
1950 McCarthy launches anticommunism campaign. Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/
1954 Brown vs. Board of Education . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1955 Rosa Parks refuses to give up her seat . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1955 Emmett Till is lynched. Source: Metress, Christopher. 2002. The Lynching of Emmett Till: A Documentary Narrative. University of Virginia Press.
1957 Salgo v. Leland Stanford Jr. University Board of Trustees . Source: Beauchamp, Tom and Ruth Faden. A History of Informed Consent. New York: Oxford University Press, 1985.
1961 9 of every 10 physicians do not disclose diagnoses of cancer to their patients. Source: Reiser, Stanley Joel. "Words as Scalpels: Transmitting Evidence in the Clinical Dialogue." http://utmed.com/studynotes/pd/WordsasScalpels.doc
1962 Drug Amendments of 1962. Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1963 Martin Luther King, Jr., I Have a Dream . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1964 The Civil Rights Act of 1964. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1964 One documented lynching of a black American. Source: l. "Lynching in America: Statistics, Information, Images," Famous Trials: The Shipp Trial. Doug Linder, 2003. http://www.law.umkc.edu/faculty/projects/ftrials/shipp/lynchstats.html
1965 Watts riots in Los Angeles. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1968 Martin Luther King Jr. is assassinated . Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1969 Neil Armstrong walks on the moon. Source: "Primary Mission Accomplished: 1969," NASA History Office. Updated February 5, 2003. http://www.hq.nasa.gov/office/pao/History/SP-4214/ch9-5.html
1969 Anti-Vietnam War demonstration in DC. Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/index.html
1970 Food and Drug Administration clarifies the Drug Amendments of 1962. Source: Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990. New York: Cambridge University Press, 2000.
1974 Nixon resigns . Source: "Timeline," The American Experience: Vietnam Online. © 1997. PBS Online. http://www.pbs.org/wgbh/amex/vietnam/time/index.html
1979 Moral Majority founded. Source: "The Moral Majority." The Columbia Encyclopedia Online, Sixth Edition. © 2002 Columbia University Press. http://www.bartleby.com/65/e-/E-MoralMajo.html
1982 Scientists first use the term "AIDS" . Source: "In their own words: NIH Researchers recall the early days of AIDS," NIH. http://aidshistory.nih.gov/timeline/index.html
1984 Jesse Jackson makes bid for the Presidency. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1986 Martin Luther King Day established. Source: "Martin Luther King, Jr." Wikipedia. http://en.wikipedia.org/wiki/Martin_Luther_King
1991 Clarence Thomas nomination and hearings. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1992 Rodney King verdict. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1992 Carol Mosely-Braun elected to Senate. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1995 OJ Simpson trial. Source: Levine, Michael L. 1996. African Americans and Civil Rights: From 1619 to the Present. Phoenix, AZ: Oryx Press.
1996 63.5% of blacks registered to vote.. Source: Thernstrom, Stephen and Abigail Thernstrom. 1997. America in Black and White: One Nation, Indivisible. New York: Simon and Schuster.
1997 Clinton's apology to victims of PHS Syphilis Study. Source: "Remarks by the President in Apology for Study Done in Tuskegee," May 16, 1997. http://clinton4.nara.gov/textonly/New/Remarks/Fri/19970516-898.html

Thanks to Kara Lochridge and Summer Johnson for preparing this resource. An earlier, longer version by Victoria Berdon and Jennifer Flavin is also available.

Indiana University and WisdomTools, Inc., have made every effort to secure the necessary permissions and provide appropriate credits for materials used in this WisdomTools ScenarioTM and the related resources. In the event any questions arise as to the use of any material, we express regret for any inadvertent error and will be pleased to make the necessary corrections.

Development of The Least of My Brothers was funded by the Poynter Center for the Study of Ethics and American Institutions, Indiana University-Bloomington, and the National Institutes of Health.


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