The Tuskegee Syphilis Study. Fred Gray

in his classic novel, Invisible Man.

      For the purpose of examining the Tuskegee Syphilis Study, the point is that the men who were chosen as participants for this study came out of the cotton culture of the 1930s. They were for the most part very poor, not well educated, worked very hard in a cruel economic situation, and were by custom and social conditions accustomed to submitting to authority and uniforms, whether that uniform was that of the law or the white coats and dresses of doctors and nurses.

      As for those doctors and nurses, health care in 1932 was largely inaccessible in Macon County. There were very few doctors in Macon County and only two hospitals. Macon County Hospital was exclusively used by whites, and John A. Andrew Memorial Hospital was located on the campus of Tuskegee Institute. Andrew Memorial Hospital’s primary purpose was to provide health care for the students and officials of the College. It was also the center for providing health care for the local African American community, particularly for maternity patients, infant care, and treatment for tuberculosis. Dr. Eugene Dibble and Dr. Thomas Campbell were the only African American doctors in Macon County, and they were connected with John A. Andrew Memorial Hospital.

      Historian Robert J. Norrell referred to sociologist Charles S. Johnson’s research in Macon County. That research was part of a study financed by the Rosenwald Fund to study the extent of syphilis in the county. Norrell writes:

      Physicians working for the United States Public Health Service discovered in 1930 that thirty-six percent of fourteen hundred black men examined had the disease. They also found that health conditions for rural blacks in Macon County were miserable generally. Their diet consisted largely of salt pork, hominy grits, cornbread, and molasses; fresh meat, fresh vegetables, fruit, and milk were rarely included. Malnutrition was chronic, and they were afflicted by many diet-related illnesses. Most of the county’s poor blacks could not afford medical care.

      I have to point out that a similar survey would have found much the same thing if it had examined the poorest whites in the county, too, for their health conditions were not much better. However, a greater proportion of blacks were in these circumstances, and even the poorest whites did not carry the additional burden of legalized segregation. Nevertheless, in the thirties, most rural people simply did not have medical care. Children were born at home with their births assisted not by doctors but by midwives. Very few African Americans were treated by a doctor, and for African American males, the percentage was even lower. I am sure that only a handful of the 623 participants in the Tuskegee Syphilis Experiment, prior to being involved, had ever been treated by a physician. This was the state of health care in Macon County at the time the men were selected to enter the Experiment.

       3

       Origins of the Study

Syphilis was a terrible disease. It still is, of course, but it is easily treated today by a number of antibiotics. In 1932, that was not the case, and one can appreciate both the scientific zeal and the humanitarian instincts of those who originated the Tuskegee Syphilis Study at a time when there was no simple solution to what amounted to an epidemic among certain population groups.[1]

      Before beginning work on this case, I, like most lay people, knew what syphilis was, but I knew little of the particulars of the disease. From the documents in this case and from talking with the medical professionals, I learned enough to explain that syphilis is caused by a bacterium, a spirochete, that lives only in humans and is almost always transmitted from one person to another by intimate sexual activity. However, congenital syphilis can also result when an infected pregnant women passes the disease to her developing baby, who can be born deaf, mentally retarded, blind, or with other disorders.

      Once the syphilis bacterium is inside a person’s body, the disease develops through three stages.

      First, within ten to ninety days after infection, a small red pimple will appear at the site of infection, usually on the genitals. This pimple turns into a sore which is called a chancre. There is usually no pain or soreness and the victim may not even notice the chancre. In thirty to forty days, the chancre goes away.

      The secondary stage begins about a week later and lasts for several weeks. The main visible sign is a rash that can appear, especially on the palms or the soles of the feet. Some people experience hair loss, fever, open ulcers, and headaches, while others have only very mild symptoms and may not even notice them. Any open ulcers during this phase are extremely infectious to others.

      Between the second and third stages, there is a latent period which can last for years. During the latency, syphilis can only be detected by a blood test. Left untreated during this latent period, the third or late stage of the disease can occur at any time for the rest of the victim’s life.

      In the late stage, the syphilis bacterium attacks the neurological and cardiovascular systems of the body, damaging the heart, brain, and spinal cord, but also the skin, bones, and other organs. The victim’s heart may fail, he or she may develop mental illness, may go blind and/or deaf, and may suffer paralysis, or other debilities. Although some people live to a ripe old age with syphilis and never have severe symptoms, others may be devastatingly ravaged by the disease. Persons with advanced syphilis may develop huge, encrusted ulcers on their skin, especially near their joints. Also, their brains may be affected to the point that they literally go stark raving mad. The bacterium also may attack the blood vessels or the heart, causing aneurysms that may burst, resulting in sudden death.

      After Mr. Charlie Pollard came to see me in 1972 and I agreed to represent him in a lawsuit against those responsible for the Tuskegee Syphilis Study, my staff and I began to research the study’s origins. As the case expanded, we included other researchers and the staffs of our associated counsels. Because the study had existed for so long, many of the original documents were filed away in long-forgotten archives. Gradually, the details emerged.

      As mentioned in the previous chapter, the study began as a project of the Julius Rosenwald Fund, which took an active interest in both education and health care for African Americans in the rural South. Julius Rosenwald was a Jewish philanthropist who had helped build the Sears and Roebuck Company mail order business. He became a patron of Booker T. Washington and the Tuskegee Institute and also financed the construction of a large number of schools in parts of the South where state support for the education of African Americans was weak to non-existent; the very first of those schools was built in Macon County. Rosenwald’s foundation sought to improve race relations in general as well as the specific health and social problems facing African Americans in the Southern states.

      A large-scale public effort to combat venereal disease, including syphilis, had been underway in the U.S. since World War I, but in rural areas vast numbers of poor people were still unable to obtain any treatment. In Alabama, for example, some fourteen free clinics operated by the State Board of Health were treating ten thousand indigent patients by 1930. Yet most of these were in urban areas. In rural areas, the public health service gave private doctors free drugs for treatment of indigents, but the physicians were allowed to charge a two-dollar fee and many of the poorest patients could not afford that amount.

      The Rosenwald Fund, meanwhile, sought an alliance with the U.S. Public Health Service (PHS) to expand medical services to the poorest African American areas of the South. In addition to its work in education and social services, the Fund was helping to build hospitals and clinics and was also promoting the hiring of African American nurses and doctors and the training and hiring of African American public health personnel. To oversee this work, Dr. Michael M. Davis was named medical director of the Rosenwald Fund. In 1929, Davis went to the surgeon general of the U.S. Public Health Service to ask for assignment of a PHS adviser to the Rosenwald medical efforts in the South. Dr. Taliaferro Clark, then head of the Public Health Service’s Venereal Disease Division, a Virginian who had been with the Public Health Service since 1895, was given this assignment by then Surgeon General Dr. Hugh S. Cumming.

      After appointing Clark as the Rosenwald adviser, Cumming then asked Davis for a Rosenwald grant to provide follow-up treatment