This resource presents the historical facts which are the basis for the fictional dialogues that comprise The Least of My Brothers. It is important to note that while the case is historically accurate in its broad sweep, the actual conversations presented in each scene are fictional, as stated in the introduction. Sources are listed at the bottom of this file. Close this window when you are ready to return to the scenario.
Dr. Barr explains to Mr. Wilson that the local black community is desperately poor and uneducated. Barr hopes that through the Tuskegee Institute he can develop a program to understand the extent of and treat the syphilis that seems so prevalent.
The Tuskegee Institute is located in Tuskegee, Macon County, Alabama.
Tuskegee Normal and Industrial Institute was founded in 1881 by Booker T. Washington, an educator and former slave who became an influential African American leader in the United States. The institute later became Tuskegee University.
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The Institute eventually grew into a major educational center for blacks. It included classes in academic subjects as well as professional training for nurses and doctors. Just prior to World War I, the John A. Andrew Hospital was founded in order to improve medical services to the community. The hospital did not, however, have "sufficient funds" to make a "significant contribution to community health" (Jones 64). The community had an unusually high rate of chronic health problems.
In 1926, it was apparent that the poor health accompanied by extreme poverty and lack of education was preventing blacks from improving their lives. Sometimes they were forced to live in conditions even worse than those of slavery. Former slaves who had become share-croppers were especially affected by chronic health problems that impaired their ability to work. A study conducted by the federal government reported that the prevalence of syphilis in several southern counties--including Macon County, Alabama--was a startling 35 percent of the black male population of reproductive age (Jones 91).
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To increase local attention to the severity of the syphilis problem, landowner Marcus Powell writes about its threat to the health and financial success of the community. W hile the letter included in this scene is fictional, landowners were indeed concerned about the widespread health problems of their workers. Ill health limited productivity and, as a consequence, profit. Also, whites dreaded the risk of catching syphilis from untreated blacks.
In a 1904 report Dr. Brunner (chief health officer of Savannah, Georgia) "pleaded for action on behalf of blacks" for "in doing so we protect ourselves" (Jones 43).
"I knew that the majority of these plantation owners," Brunner wrote, "would give us their sympathetic good wishes in whatever we ourselves chose to do to improve the welfare and promote the happiness of the Negroes on their plantations. But if we expected them to do anything about it, I knew we had to use the argument that it would be more profitable to work a healthy field hand than a sick one"(Jones 67).
Plantation owners were very happy to grant permission for the treatment of black share-croppers. One plantation owner commanded his foreman: "Tell those niggers that the health doctor will be at Possum Hollow school tonight. He's got some government medicine to cure the blood disease. A lot of these niggers have got blood trouble, sickly, no count, lazy; but maybe it's not their fault. This doctor will find out" (Jones 68).
Dr. Barr finds out the Tuskegee Institute has received a federal grant for developing the syphilis prevalence study.
In 1914, physician Ernst Boas appraised the state of knowledge on the prevalence of syphilis in the rural South, and found that it had not yet been systematically evaluated: "If a southern physician is asked what percentage of negroes in his experience are syphilitic, his offhand estimate will usually be about 75 per cent. When further questioned, he will usually admit, however, that he has no accurate data on the subject."
The purpose of Boas's study was two-fold. First, he wanted "to call attention to the lack of reliable statistics on the prevalence of syphilis in the Negro" and, second, he wanted to compile and present all of the statistical information on the prevalence of syphilis in the black population that was available. Boas effectively demonstrated that the available data was inadequate to accurately assess the incidence of syphilis in the black population.
In 1916, Edward B. Vedder, a captain in the Medical Corps of the United States Army, conducted an examination of the prevalence of syphilis among army recruits. He concluded, quite dramatically, that "syphilis is so prevalent among negroes that it is possibly the greatest single factor in the production of disability and high mortality rates among the race" and that "syphilis is a greater menace to the public health than any other single infectious disease, not even excepting tuberculosis."
In a 1928 article entitled "Veneral Disease Control: Problems and Methods," John Stokes called for action in the struggle against widespread venereal disease. He wrote:
"It will not do to continue indefinitely the practice of regarding a method that displays the effectiveness of mechanical and chemical prophylaxis as merely a war-time expedient. To wait until a person develops disease, when even one in a hundred might be saved by some easily applied medical measure, is an anachronism in public health procedure for which morals cannot stand sponsor."
Later, Stokes referred specifically to problems related to syphilis: "in the syphilologic field, in which, of course, I see the trends more clearly, the tremendous worth of an infection-controlling drug has recently been suggested by studies. They attribute the decline in syphilis in the countries surrounding France to the French substitution of bismuth, an inferior spirillicide, for arsphenamine." The substitution of bismuth for arsphenamine resulted in a fifty percent decrease in syphilis cases. Finally, in 1929, the United States Public Health Service (USPHS) resolved to officially investigate the prevalence of syphilis in Macon County, Alabama.
It was argued that the solution to inadequate treatment and re-infection was to test "large groups of Negroes . . . and devise some means of treatment; not in the hope of effecting a cure but to make as many of these patients who present a four-plus Wassermann noninfectious." The USPHS did not, it claimed, have the financial resources to fund research aimed at finding a cure. The goal was simply "to render infectious patients noninfectious" (Jones 57) Thus, in the summer of 1929, the Mississippi syphilis survey changed shape. It became a treatment demonstration.
In the beginning, the infection rate for blacks was nearly twice that of whites: "Macon County's infection rate threatened to reinforce the image of syphilis as a black disease" (Jones 74). The causes of the staggering inequality in infection rates were manifest: blacks lived in poverty-stricken conditions made worse by the Depression; their access to treatment facilities was limited; the disease had become endemic, or transmitted from mother to child in utero. In Bad Blood: The Tuskegee Syphilis Experiment, James Jones tells us that 62 percent of the patients admitted to the program in Macon County had congenital syphilis (76).
In a letter from Dr. Baxter we learn that there is as yet no cure for syphilis. Rather, the most one can try to do is to reduce contagion, treat the sores, and see the sick regularly.
In 1929, a trial program for testing and treating infected Macon County blacks was underway. This "pilot treatment program was a joint venture of the Julius Rosenwald Fund and the Public Health Service. In 1929, the Fund asked the PHS for assistance in developing health programs for southern blacks" (Jones 52).
The Julius Rosenwald Fund "was a philanthropic organization that played a key role in promoting the welfare of black Americans. Booker T. Washington drew Julius Rosenwald into the struggle, and the fund became famous for building schools for blacks in the South." It persisted in its "work on behalf of blacks, developing programs in medical economics, library service, social studies, general education, and race relations" (Jones 52).
Nurse Jones confirms a diagnosis of "bad blood" (the local term for the symptoms that accompany syphilis) and provides a mercury rub treatment.
Salvarsan--a preparation of arsenic administered by injection--had been used to treat syphilis since 1910. Salvarsan was heralded as a sort of miracle cure for syphilis. However, it soon became apparent that the "magic bullet," as salvarsan was called, was not, in fact, a cure. Within a year of treatment, patients thought to have been cured had relapsed. What had been discovered was chemotherapy: "the drugs were highly toxic," so "the rate and amount of treatment had to be carefully calculated to destroy the disease without killing the patient" (Jones 45).
In the years following 1910, physicians discovered that the two arsenic derivatives commonly used in the preparation of salvarsan (arsphenamine and neoarsphenamine) had to be supplemented by applications of mercury or bismuth ointments. Even the augmented formula did not have ideal results. Physicians eventually resigned themselves to the fact that curing syphilis was not an easy matter, although they retained their optimism that the disease would be eradicated in their lifetimes (Jones 46).
In 1932 Dr. Taliaferro Clark, the surgeon general of the PHS Syphilis Study at Tuskegee, called for a six- to eight-month study which included a partial program of treatment for all those examined. Initially, the study was to be "strictly nontherapeutic" (Jones 112). Clark's program provided for some treatment. Again, the goal was "to render infectious patients noninfectious," not to cure them (Jones 57).
Despite Clark's earnest desire to hear criticism of the study, no one argued that is was morally wrong: "consensus formed the functional equivalent of moral sanction" (Jones 112).
The prevalence of syphilis is so high that even Dr. Barr is surprised.
Based on a survey begun in 1926 of twenty-five communities across the United States, the Public Health Service reported that the prevalence of syphilis among patients "under observation or treatment" was 4.05 cases per 1,000 individuals. The rate for whites was 4 per 1,000; the rate for blacks was 7.2 per 1,000--nearly twice that of whites (Jones 74). The 1930 syphilis control demonstration conducted in six counties in the rural South (Scott County, Mississippi; Tipton County, Tennessee; Glynn County, Georgia; Pitt County, North Carolina; Albemarle County, Virginia; and Macon County, Alabama) yielded a startlingly higher incidence of syphilis: 195 cases per 1,000 individuals. Macon County had the highest rate: "a shocking 36 percent" (Jones 74).
Earl Johnson advises his friend Leon Woods to go to the Institute for treatment of his headache and pulmonary symptoms; it might be "bad blood."
The subjects at Andrews Hospital thought they were being treated for rheumatism or "bad stomachs." They were not told that they were being examined for syphilis. Those found to be infected were told they had "bad blood." An official at the Center for Disease Control (CDC) claimed that he believed the term "bad blood" to be synonymous with "syphilis" in the black community. Other officials, however, claimed never to have heard that. In 1972 Charles Pollard, a survivor of the PHS Syphilis Study at Tuskegee, told the New York Times that "they just kept saying I had the bad blood-they never mentioned syphilis to me, not even once" (Jones 5-6).
Often, blacks did not distinguish between one or another malady. Instead, they vaguely referred to their illnesses as "bad blood." Most blacks did not associate "bad blood" with syphilis infection, even if they knew of syphilis (and many did not). If they did know of syphilis, it is likely that they believed that "the disease [was] produced by a blood poison," as is suggested by physician Charles Scudder's Handbook for Young Men, published in New York in 1892.
Dr. Barr finds out that the Rosenwald Fund is withdrawing its support to the Tuskegee Institute because the Alabama State Board of Health did not fulfill their commitments.
The Rosenwald Fund had a "firm policy of requiring state and local agencies to share expenses" (Jones 85). However, "neither the local nor the state officials could muster enough money for health work (especially among blacks)" (85). Because of the Great Depression, public services in Alabama were significantly reducing expenditures, and "the Fund could not assume the lion's share of such an enormous burden. It, too, was experiencing financial difficulties as the market value of its stock declined" (88).
Instead of looking at the loss of funding as a failure, Dr. Barr suggests a new study that would examine the progress of untreated syphilis. Inspired by the Norwegian Oslo Study of untreated syphilis, Barr proposes to test the theory that syphilis in the Negro attacks the nervous system more than it does the cardiovascular system.
After the Rosenwald Fund withdrew funding, Dr. Clark wrote a final report. Instead of bringing the study to a halt, the report aroused interest in a new study which, as James Jones writes in Bad Blood, "evolved into the longest non-therapeutic experiment on human beings in medical history" (91).
In 1928, Sweden's Oslo Study reported on the physiological manifestations of untreated syphilis in several hundred white males. The doctors who conducted the study had not actively treated or withheld treatment from these subjects. Rather, they had relied for their conclusions on case histories of the deceased (Jones 93). It had been found that "cardiovascular damage was common, while neurologic complications were rare" (Jones 93).
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The Tuskegee scientists believed that syphilis would manifest itself differently in black subjects. They predicted that blacks would suffer more neurological damage than did the white subjects. In a September 1932 letter to Dr. Clark, Dr. Joseph Earle Moore of the Venereal Disease Clinic of Johns Hopkins University wrote that "syphilis in the Negro is in many respects almost a different disease from syphilis in the white" (qtd. in Jones 106).
The PHS Syphilis Study at Tuskegee was by no means the only occasion in which scientists explored the alleged biological differences between blacks and whites. It followed in a well-established chain of similar investigations, including "A Comparison of White and Colored Troops in Respect to Incidence of Disease," conducted in 1919 by Lieutenant Colonel A. G. Love and Major C. B. Davenport of the National Academy of Sciences and "The Investigation of Racial Differences Prior to 1910," published in 1934 by Drs. Charles S. Johnson and Horace M. Bond in the Journal of Negro Education.
Dr. Barr explains that his proposed study will advance the cause of medical research and improve the human condition. His study will more extensively test those infected, but provide only partial treatment. When questioned, he discounts the suggestion that such treatment might be inappropriate.
Dr. Clark seemingly had no misgivings about the study he was proposing. He spoke with confidence and enthusiasm about the experiment and its potential outcomes and even seemed to suggest that the study showed "concern" for black Americans. In Bad Blood, James Jones writes:
"The fate of syphilitic blacks in Macon County was sealed (at least for the immediate future) regardless of whether an experiment went forward. Increasing the store of knowledge seemed the only way to profit from the human suffering there. Such a study would be an expression of concern for Negro health problems" (94).
Members of Macon County's black community are offered a "last chance" for a "very special examination," to be followed by "a very special treatment" for bad blood.
The text of the letter reproduced below is from a letter issued in 1933 by Dr. Raymond A. Vonderlehr (in charge of field work for the study.) Vonderlehr chose the heading "Macon County Health Department" and the subheading "Alabama State Board of Health and U.S. Public Health Service Cooperating with Tuskegee Institute." He did not mention that the men would be subjected to lumbar punctures. He referred only to a "special examination" and a "special treatment." The letter closes with: "REMEMBER THIS IS YOUR LAST CHANCE FOR SPECIAL FREE TREATMENT. BE SURE TO MEET THE NURSE."
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The original letter is in the archives of the United States Public Health Service, Division of Venereal Diseases, Record 90.3.5. A copy is also printed in Susan Reverby's book, Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Also in Reverby's Tuskegee's Truths is a photo of a woman reading a 1930s flyer entitled "Colored People, Bad Blood, Free Blood Tests, Free Treatment." The photo is archived in the National Library of Medicine and is shown below:
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Continuous monitoring of 399 syphilis patients (and 201 non-infected control subjects) is proposed, to last through the subjects' autopsies. Ultimately, the researchers want to autopsy as many subjects as possible to gain the most reliable understanding of the natural course of syphilis in blacks.
The PHS Syphilis Study at Tuskegee involved 399 men who were infected with syphilis. An additional 201 men who were not infected with the disease served as controls. All of the syphilitic men were in the late stage of the disease when the study began (Jones 1).
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Nurse Jones
Nurse Jones is modeled after Nurse Eunice Rivers, who graduated from Tuskegee Institute with a nursing degree in 1922. In 1931 she became the "special assistant to the Public Health Service on detail in Macon County for the study of untreated syphilis in the Negro male" (Jones 111). She played a central role throughout the study-rounding up men for testing, doing at-home follow-ups, driving the men to appointments, getting families to consent to autopsies, and enforcing the withholding of treatment from study participants. She was "the experiment's on-the-spot representative, the person with whom the subjects would have the most contact" (Jones 133).
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Rivers received national recognition. She won the Oveta Culp Hobby Award in 1958: "the highest commendation HEW [Health, Education and Welfare] can bestow on an employee," for which "she received a framed certificate praising her for 'notable service covering 25 years during which through selfless devotion and skillful human relations she had sustained the interest and cooperation of the subjects of a venereal disease control program in Macon County, Alabama'" (Jones 169).
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Study subjects Earl Johnson and Leon Woods discuss the "treatment" Earl received at the Institute. Leon wonders why he is not a candidate for this treatment--after all, he has bad blood, too.
The "special treatments" to which Dr. Raymond A. Vonderlehr (in charge of field work for the study) referred in his recruitment letter of 1933 were lumbar punctures-required to diagnose neural syphilis. The procedure was extremely painful, had no therapeutic value, and often caused side effects, such as severe headaches. In rare cases, lumbar punctures resulted in paralysis or death (Jones 94-95).
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A new doctor learns that there is a "do not treat" list. If a study subject gets treatment, he won't get the "benefits" (free meals and pain killers) anymore.
In the early years of the PHS Syphilis Study at Tuskegee there was little danger that the subjects would receive treatment for syphilis, because the Rosenwald Fund had withdrawn its support of syphilis control programs in the area. In 1937, however, the Rosenwald Fund renewed its support for such programs and sent a black physician, Dr. William B. Perry of the Harvard School of Public Health, to Macon County. This alarmed the heads of the study. They worried that "treatment activities might endanger the experiment" (Jones 162). To thwart this possibility, Dr. Raymond A. Vonderlehr (in charge of field work for the study) arranged to have Nurse Eunice Rivers--the study's "on-the-spot representative" (Jones 133)--serve as Dr. Perry's assistant. Dr. Perry agreed to cooperate with the study, and Nurse Rivers's presence at his clinics prevented subjects from obtaining treatment.
Dr. Reginald D. James, a black physician involved with public health work in Macon County between 1939 and 1941, recalled: "When we found one of the men from the Tuskegee Study she would say: 'He's under study and not to be treated'" (Jones 162).
Another study subject dies. Dr. Barr persists in believing in the value of the study: "To find a cure, you have to understand the disease."
In a letter to a colleague, Dr. Raymond A. Vonderlehr (in charge of field work for the study) wrote that "everyone is agreed that the proper procedure is the continuance of the observation of the Negro men used in the study with the idea of eventually bringing them to autopsy" (Jones 132). In Bad Blood: The Tuskegee Syphilis Experiment, James Jones writes that performing autopsies on the men "introduced a significant addition to the experiment's protocol. . . . [A]utopsies would enable the researchers to supplement and revise their clinical assessments, yielding data that the scientific community would regard as far more reliable than studies based on clinical observations" (132).
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Here we see two views on syphilis. Two sharecroppers characterize bad blood as, "Whatever comes on you that you don't know how it got there," and "everyone knows it when they got it." The landlord thinks it's a moral issue: "You could catch the problem before it starts if you'd just teach the Negroes clean living."
The racial attitudes of white physicians greatly influenced their perceptions of disease in blacks. Their writings often drew upon and reinforced racial stereotypes. For example, the high instance of syphilis in the black male population was attributed to what were seen as intrinsic racial characteristics: physical inferiority, sexual promiscuity, and, in some cases, a willingness to perpetuate a "ruinous lifestyle" (Jones 23). Physicians of the time wrote of "the negro's well-known sexual impetuousity" and "the utter lack of virtue and chastity so markedly characteristic of the race" (Jones 25). While the lauded chastity of white women was seen as a barrier to the spread of the disease among whites, the alleged low moral standards of black women, it was believed, ensured that syphilis would spread uncontrollably throughout the black population. One physician concluded that the blacks had become "a notoriously syphilis-soaked race" (Jones 27).
Responsibility for the spread of syphilis in the black community was seen to rest upon the black race and its physical and moral shortcomings. Unfortunately, physicians' preoccupation with the morality of the black community obscured more important explanations for the spread of the disease: restricted access (both financial and geographical) of the black community to medical professionals as well as the problem of congenital syphilis (syphilis contracted in utero). The tendency to equate physical health with moral or spiritual health was not new to the twentieth, or even the nineteenth century. The Puritans of New England saw in the annihilation of their Indian adversaries by disease further proof that they were God's chosen people; they believed that God was passing judgment on the wicked and sinful Indians and clearing the way for the Puritans to construct their "city upon a hill."
Samuel Wilson requests that the state health authorities "would refer any of the 500 subjects to the Andrew Hospital if they come to your clinics." Wilson wants to make sure they receive no treatment for syphilis, which would ruin the "integrity" of the study. In another letter, Wilson requests that the Rosenwald Fund donate monies to cover burial costs for families of deceased subjects.
The publication "Untreated Syphilis in the Negro Male: A Proposition" corresponds to an article that actually appeared in 1936 by Dr. Raymond A. Vonderlehr (in charge of field work for the study): "Untreated Syphilis in the Male Negro: A Comparative Study of Treated and Untreated Cases." See sources for the complete citation.
For more on the withholding of treatment: 2.6 Making Rounds (Summer 1933) .
The study has been criticized in a prominent medical journal. Samuel Wilson writes a defense of the study to the Public Health Service: the reason for denying fuller treatment to the subjects is lack of funds. Also, in merely months the study doctor has been able to learn more about syphilis than in 20 years of training and practice.
In 1933, Dr. Raymond A. Vonderlehr (in charge of field work for the PHS Syphilis Study at Tuskegee) resolved to resume the syphilis experiment. While his colleagues looked for approval from the Alabama Department of Public Health, Vonderlehr contacted a number of experts in the field, discussing his plans for the experiment and asking for their criticism. In a letter to the American Heart Association (AHA), he sought acceptance of the diagnoses he had made of widespread syphilitic heart disease, even though, he admitted, he had relied on "arbitrary measurements" in making the diagnoses (Jones 139). The AHA did not accept Vonderlehr's findings, rejecting them on the basis that they were "hopelessly subjective" (139). Vonderlehr, however, was undeterred. He viewed the AHA's condemnation as a mere difference of opinion. He was still "well on the way to proving that the disease affected blacks differently than whites" (Jones 140).
By the summer of 1942, this information was most certainly available to the United States Public Health Service.
Doctor Barr and Mr. Wilson discuss the advent of penicillin, its ability to mitigate infections on the battlefields, and its success in treating tuberculosis and early stages of syphilis. According to Barr, penicillin is not appropriate for study subjects because most of the subjects are in later stages (latency and tertiary), and the treatment regime is too great an undertaking for something not yet proven as curative for these stages.
Alexander Fleming discovered penicillin in 1928. It was widely used in World War II, owing in large part to the work of biologists Howard Florey and Ernst Chain. Florey and Chain took up Fleming's research and found a way to purify penicillin, making it safe and effective for use in humans. The United States Department of Agriculture first grew large quantities of penicillin in 1941. Shortly thereafter, in 1942, the drug was being used on the battlefront for preventing and curing infections in wounded American troops (Krebs H1).
In a 1998 article written for the Washington Post, journalist Brian Krebs conveyed both the significance and the newness of treatment with penicillin:
"In an infirmary in Oxford, England, a middle-aged policeman lay mortally wounded. It was 1941, and World War II was raging. German bombs were falling outside, and the man was dying from, of all things, an infection that started with a prick from a rose thorn. His health deteriorated until physicians started administering small doses of a new, virtually untested drug. The next day, amazingly, his condition began to improve. But then the supply ran out. It was an experimental substance, and no more could be obtained. The officer relapsed and died within three weeks."
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In 1945 penicillin became widely available and accepted as the treatment of choice for syphilis. Initially, however, "optimal dosage schedules had [yet] to be established" and "there was no rapid way to determine whether the long term effect of penicillin on tertiary forms of the disease would be superior to that of metallo-therapy." In 1960, optimal penicillin doses were finally standardized (Benedek 228).
Penicillin is now widely used to treat syphilis. However, the subjects of the PHS Syphilis Study at Tuskegee are not receiving it, per instructions of the researchers.
Washington Post journalist Brian Krebs wrote in a 1998 article that "penicillin was not widely available and accepted as the treatment of choice for syphilis until 1945." In 1947, the United States Public Health Service established "Rapid Treatment Centers" to treat the disease.
The standard treatment for syphilis-injections with arsenic derivatives supplemented by applications of mercury or bismuth ointments-was lengthy, expensive, and had severe side effects (and sometimes resulted in death.) It had to be administered by a physician. Even if blacks in Macon County were aware of the treatment, they had neither the financial resources to afford it nor adequate access to medical facilities. Syphilis spread rapidly in the black population because of widespread poverty and inadequate access to medical services-not, as some contemporary researchers suggested, because of "the utter lack of virtue and chastity so markedly characteristic of the race" (Jones 25). By seeking to explain the high incidence of syphilis in the black community in terms of intrinsic racial characteristics, physicians obscured more important social and economic causes.
Wilson sends a letter to physicians in Macon County updating the list of study subjects. He reminds physicians that the subjects are not to be treated for syphilis.
In the winter of 1944, news of penicillin's use in treating syphilis had begun to circulate. The medical community was aware of its efficacy on the battlefront in preventing and curing infections. Penicillin was not, however, "widely available and accepted as the treatment of choice for syphilis until 1945." In 1947 the United States Public Health Service established "Rapid Treatment Centers" to treat syphilis (Krebs H1).
Dr. Barr and Nurse Jones comment on the Nazi medical atrocities and how such things are unimaginable in America.
The Nazi doctors performed many sorts of experiments, including Dr. Josef Mengele's experiments on twins.
"The twins were examined from head to toe."
"Part of the examination consisted of tubes being forced through their noses and into their lungs. They were then ventilated with a gas which caused them to cough so severely they had to be restrained. The sputum from the lungs was collected for examination."
"They were taken into a room with tables and a hot water vat [and] were made to sit in the water until they were ready to pass out from the heat. They were then strapped to a table; their hair was plucked out trying to save the hair root."
"The twins then received several two liter enemas which caused them much pain and discomfort. The boys on different days were strapped over a bench table and their rectums were hyper descended after which they received an extensive lower gastric intestinal examination. This extensive procedure was performed without any anesthesia. The young men were crying so loud that Doctor Mengele ordered they be gagged. The next day they received a painful and humiliating urological examination. In this examination tissue samples were taken from the kidneys, prostate, and testicles. Several semen samples were forcefully taken over two days."
"After all the living data was taken the twins would be killed by a single injection of chloroform in the heart. Care was taken to insure the twins died at the same time. The twins were then dissected with the organs being sent to research centers."
[From Medical Experiments of the Holocaust and Nazi Medicine. Website.]
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A subject has been denied continuation in the study because he has received treatment elsewhere.
In 1943, penicillin had become the preferred cure for syphilis: "The PHS [had] started administering penicillin to syphilitic patients in several treatment centers across the county" (Annas and Grodin 178). However, the director of the Division of Venereal Diseases chose not to use the drug with the study subjects. He felt that "[t]he longer the study, the better the ultimate information we would derive" (179). He was not concerned with the medical status of the men in the PHS Syphilis Study at Tuskegee.
A study subject dies, apparently from old age. Autopsies have resumed, and this subject will be included.
In 1952, "The Tuskegee Study promised to become an important investigation of aging. The subjects were either old or middle aged (the youngest was forty-four in 1952" (Jones 184). This means that in 1945, when penicillin became the treatment of choice for syphilis and widely available, the subjects would have been 31 years of age or older.
In 1946, an article on the study reported "that life expectancy of syphilitics who were between the ages of twenty-five and forty-five when the experiment began was 20 percent lower than controls in the same age group." Life expectancies for the two groups grew closer. From this they concluded that "[s]yphilis shortened the lifespan of its victims appreciably, but it did most of its damage while the men were still relatively young" (Jones 185).
Nurse Jones overhears two medical students discussing withholding of medical treatment during the study and the lack of informed consent. Three perspectives on the ethics of withholding treatment come up in conversation.
By 1961, the time in which the medical students in this scene are gossiping, Donald Rockwell had published the12th paper on the study: "The Tuskegee Study of Untreated Syphilis: The 30th Year of Observation" in Archives of Internal Medicine 114 (1961), 792-98.
In 1966, Peter Buxtun, a United States Public Health Service venereal disease investigator in San Francisco, sent a letter to the director of the Division of Venereal Diseases which expressed concerns about the morality of the experiment (Jones 191).
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Included with the letter was a copy of a paper he had written comparing the PHS Syphilis Study at Tuskegee to Nazi experiments (Jones 272).
By 1968, "several American cities had exploded into race riots, and Buxtun had grown more alarmed and pessimistic about the racial implications of the experiment. 'The group is 100 per cent Negro,' he declared. 'This in itself is political dynamite and subject to wild journalistic misinterpretations.' The racial composition of the study group also supported 'the thinking of Negro militants that Negroes have long been used for 'medical experiments' and 'teaching cases' in the emergency wards of county hospitals.' Denying that the subjects were volunteers, he characterized them as 'uneducated, unsophisticated, and quite ignorant of the effects of untreated syphilis.' The excuses and justifications that might have been offered in 1932 were no longer relevant. 'Today it would be morally unethical to begin such a study with such a group,' he declared. . . . Buxtun closed by expressing the hope that the subjects had been treated or would be soon" (Jones 192-3).
After receiving letters criticizing the study and meeting with their author (the "whistle-blower"), members of the Center for Disease Control discount the negative publicity. The whistleblower's moral indignation is attributed to his youth and "generation." Officials are still confident and will continue the study; they will be honoring Nurse Jones for her contributions.
On February 6, 1969, a conference was held at the Center for Disease Control to discuss the PHS Syphilis Study at Tuskegee. As James Jones indicates in Bad Blood: The Tuskegee Syphilis Experiment, "no one with training in medical ethics was invited to the meeting, none of the participants was black, and at no point during the discussions that followed did anyone mention the PHS's [Public Health Service's] own guidelines on human experimentation or those of other federal agencies" (193). In fact, when the possibility of offering treatment was suggested it was readily discounted with the assumption that, as Jones writes, "the subjects probably would not accept therapy even if it were offered" (196). There was still a feeling that the study had much to contribute to medical science and "since [the health officers] had convinced themselves that the men could not benefit from treatment, it followed in their minds that science should be permitted to learn all it could" (196). The formal conclusion reached was not that the study was morally wrong. However, the officers displayed a real fear that the experiment would become "known publicly" (Jones 201).
Having failed to stop the study by contacting government authorities, the "whistle-blower" successfully exposes the study via a newspaper article. Consequently, Senator Kennedy holds hearings during which the details of the study are clearly presented to the public. Due to public outrage, the study is finally brought to an end.
In Bad Blood: The Tuskegee Syphilis Study, James Jones concludes that "in the end it was Peter Buxtun (aided by the press) who stopped the Tuskegee Study" (203).
Early in 1972, Buxtun complained of the study to Edith Lederer, an international affairs reporter with the Associated Press in San Francisco. On July 25, 1972, the story appeared in the Washington Star.
What follows is an excerpt from attorney Fred Gray's statement to the press on April 8, 1997, taken from Susan Reverby's Tuskegee Truths: Rethinking the Tuskegee Syphilis Study:
"Sixty-five years ago, beginning in 1932, the United States government, through its public health service, committed one of the greatest frauds, injustices, and misrepresentations against 623 African-Americans who were citizens of Macon County, Alabama. The men were misled into participating in a study of untreated syphilis sponsored, financed, and supported by the federal government for over 40 years. They never gave their consent to be involved in the Study, nor did they realize that they were part of a Study until the story broke in July of 1972."
| Fred Grey. (From Faces of Tuskegee. Website.) | Survivor Charles Pollard. (From Faces of Tuskegee. Website.) | |
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Also in Reverby's book are portions of the 1973 Kennedy Hearings in Washington on Tuskegee:
Senator Kennedy: What were the shots for, to cure the bad blood?
Mr. Pollard: Bad blood, as far as I know of.
Senator Kennedy: Did you think they were curing bad blood?
Mr. Pollard: I didn't know. I just attended the clinic.
Senator Kennedy: They told you to keep coming back and you did?
Mr. Pollard: When they got through giving the shots, yes. Then they gave us that spinal puncture.
Senator Kennedy: Did they tell you why they were giving a spinal puncture?
Mr. Pollard: No.
Senator Kennedy: Did you think it was because they were trying to help you?
Mr. Pollard: To help me, yes.
Senator Kennedy: You wanted some help?
Mr. Pollard: That is right. They said I had bad blood and they was working on it.
Annas, George J. and Grodin, Michael A., eds. The Nazi Doctors and the Nuremberg Code. New York: Oxford University Press, 1992.
Benedek, Thomas. "The 'Tuskegee Study' of Syphilis: Analysis of Moral versus Methodological Aspects." In Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Edited by Susan M. Reverby. Chapel Hill: University of North Carolina Press, 2000. 213-235.
Boas, Ernst Philip, M.D. "The Relative Prevalence of Syphilis among Negroes and Whites." Social Hygiene. Vol. I. New York: The American Hygiene Association, 1914.610-616.
Brandt, Allan M. "Racism and Research: The Case of the Tuskegee Syphilis Experiment." In Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Edited by Susan M. Reverby. Chapel Hill: University of North Carolina Press, 2000. 15-33.
Earl, William, M.D. The Illustrated Silent Friend: Being a Complete Guide to Health, Marriage, and Happiness. New York, 1858.
Gould A. and Dubois, Franklin L. The Science of Regeneration. Chicago: Advanced Thought Publishing, 1911.
Graham, Sylvester. Lecture to Young Men. Boston, 1848.
Johnson, Charles. "The Shadow of the Plantation: Survival." In Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Edited by Susan M. Reverby. Chapel Hill: University of North Carolina Press, 2000. 41-58.
Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment. New York: The Free Press, 1993.
Krebs, Brian. "How a Lowly Fungus Saves Human Lives." In The Washington Post. 11 March 1998. H01.
Rockwell, Donald et al. "The Tuskegee Study of Untreated Syphilis: The 30th Year of Observation." Archives of Internal Medicine 114 (1961), 792-98.
Scudder, Charles D., A.M., M.D. Handbook for Young Men. New York: White Cross Community YMCA of the City of New York, 1892.
Stokes, John H. "Venereal Disease Control: Problems and Methods." Journal of the American Medical Association 90 (10 March 1928), 743-747.
Vedder, Edward B. "The Prevalence and Prevention of Syphilis." Social Hygiene. Vol. II. New York: The American Hygiene Association, 1916. 375-381.
Vondherlehr, R.A. and Usilton, Lida J. "The Extent of the Syphilis Problem at the Beginning of the World War II." In New York State Journal of Medicine 43:19 (1 October 1943), 1825-1829.
---. "Untreated Syphilis in the Male Negro: A Comparative Study of Treated and Untreated Cases." In Venereal Disease Information 17 (1936), 260-65 and The Journal of the American Medical Association 107 (1936), 856-60.
Images
"Tuskegee Institute, Tuskegee, Ala., April 5th, 1918." Taking the Long View: Panoramic Photographs 1851 - 1991. Prints and Photographs Division, Library of Congress. Online. Available: http://lcweb2.loc.gov/ammem/pnhtml/pnhome.html.
Johnston, Frances Benjamin. "History class, Tuskegee Institute, Tuskegee, Alabama." 1902. African American Odyssey. Prints and Photographs Division, Library of Congress. Online. Available: http://lcweb.loc.gov/exhibits/odyssey/archive/06/0603001r.jpg.
Booker T. Washington and financial supporters at Tuskegee Institute. Association for the Advancement of Blacks in Health Sciences. Online. Available: http://www.aabhs.org/tusk.htm.
"Booker T. Washington." 1890. African American Odyssey. Prints and Photographs Division, Library of Congress. Online. Available: http://lcweb.loc.gov/exhibits/odyssey/archive/06/0602001r.jpg.
Text of Oslo Study. "The Oslo Study." Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
Vonderlehr's letter. "Dr. Raymond A. Vonderlehr." Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
"A black woman reads a flyer: 'Colored People, Bad Blood, Free Blood Test, Free Treatment.'" Images from the History of Medicine. History of Medicine Division, National Library of Medicine. Online. Available: http://wwwihm.nlm.nih.gov/.
"Unidentified African American family." The Jackson Davis Collection of African American Educational Photographs. Special Collections Department, University of Virginia Library. Online. Available: http://www.lib.virginia.edu/speccol/jdavis/.
"Nurse Eunice Rivers." Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
Nurse Eunice Rivers and study team. Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
"Spinal tap, 1933." Tuskegee Study Files. Archives of the Center for Disease Control. Online. Available: http://www.cdc.gov/.
Erikson, Lou. "Secret Tuskegee Study." 1972. Clancy, Neil, M.D. "History of Infectious Diseases." History of Medicine Lecture Series. University of Florida Society for the History of Medicine. Online. Available: http://www.medinfo.ufl.edu/other/histmed/clancy/slide73.html.
"Thanks to Penicillin . . . He Will Come Home!" The Fight for Life: Medical Innovation During War. mcatmaster.com. Online. Available: http://www.mcatmaster.com/medicine&war/penicillinposter.htm.
Children subjected to medical experiments in Auschwitz. Mengele's Twins: Children of Auschwitz. Holocaust Crimes, Heroes, and Villains. Online. Available: http://auschwitz.dk/Mengele/index.htm.
"Buxtun." Lasting Legacy: An Apology 65 Years Late. Online NewsHour. PBS. Online. Available: http://www.pbs.org/newshour/bb/health/may97/tuskegee_5-16.html.
"Fred Gray." Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
"Charles Pollard." Faces of Tuskegee. Michigan State University. Online. Available: http://www.msu.edu/course/hm/546/tuskegee.htm.
Thanks to Victoria Berdon for undertaking the research for this Resource and writing early drafts. Jennifer Flavin edited and prepared the current version.
Indiana University and Wisdom Tools, Inc., have made every effort to secure the necessary permissions and provide appropriate credits for materials used in this Time Revealed Scenario 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 (Grant Number 1 T15 AI07601).
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