The Tuskegee Syphilis Study. Fred Gray

had involved only white Norwegians; the Rosenwald surveys promised a method of getting comparative data on black Americans.

      Males were chosen for the survey because their sex organs are external. Males are much more likely than females to notice syphilitic chancres, and are therefore more likely to give an accurate medical history concerning the date of infection.

      This was the Study plan. It was thought out from the scientific perspective, although its central premise, that reasonably accurate date-of-infection data could be obtained from the subjects, was known to be dubious at best. Otherwise, the Study was well designed to yield useful information. Its implementation was a disaster because almost no thought was given to the people who were to become its victims.

      From the start the program was based upon making Macon County African Americans believe that this was another public health treatment program. The Rosenwald Foundation’s earlier efforts had been enormously successful and had created a deep reservoir of good will among the local farmers and laborers. The Rosenwald files at Fisk University contain hundreds of appreciative letters and interview reports from Macon County residents.

      This good will was systematically exploited in a manner perhaps never fully understood by the responsible government agencies. For example, Dr. Clark wrote that Macon County’s high prevalence of untreated syphilis was a “ready-made situation, if I may be permitted to use this phrase,” but “in order to secure the cooperation of planters in this section it was necessary to carry on this study under the guise of a demonstration and provide treatment for those cases uncovered found to be in need of treatment.” That course, pretending that this was another Rosenwald-type demonstration and treatment program, was necessary not only to get the cooperation of the white planters, but also of the local African Americans.

      From the beginning, the white doctors and public health officials involved knew that they were misleading the African American test subjects about the true purpose of their efforts in Macon County. Their correspondence and reports reveal that they knew they had to pretend to provide treatment in order to secure the participation of the African Americans to be tested, yet they had to withhold treatment in order to achieve their study results. As we shall see, they failed on both counts.

      In the early fall of 1932, Dr. Clark traveled to Alabama to make preparations for the experiment. He met with several groups whose cooperation he felt was essential to the success of the program.

      One group was the Alabama Board of Health and its director, state health officer Dr. J. N. Baker. Jim Jones, who assisted my legal team in researching the case, later wrote in his book Bad Blood that “Dr. Baker extracted an important concession from Dr. Clark in exchange for his approval and cooperation: Everyone examined and found to be syphilitic would have to be treated. How much treatment was the problem. Since Dr. Clark planned to finish the study within six to eight months, it would have been pointless for Dr. Baker to have insisted upon the full program of treatment necessary to cure syphilis. That required more than a year to complete.” According to Jones, the understanding reached between Clark and Baker required “every patient who was examined and found to have syphilis, including those who were selected for the study, was supposed to receive eight doses of neoarsphenamine and some additional treatment with mercury pills, unless treatment with either drug was contraindicated on medical grounds.”

      Jones speculates that Dr. Baker had two primary motivations. First, giving at least minimal treatment for the Macon County syphilitics was the medically humane thing to do and, while it might not cure them, it would make them less contagious to others. Second, Dr. Baker knew that the “Rosenwald Fund’s syphilis control demonstration had increased public awareness of what a menace the disease posed in the area. Dr. Baker may have reasoned that white employers would not cooperate unless the physicians offered some relief.”

      The support of white planters in Macon County was evidently considered important for getting out the word to the potential African American test subjects, but Clark did not meet with the planters on his September trip. That was left to the project staff once the work was actually underway.

      Also key was to obtain the cooperation of Tuskegee Institute and the African American doctors at the Institute’s Andrew Hospital. Both Dr. Eugene H. Dibble, the Medical Director of the hospital, and Dr. Robert R. Moton, the President of the Institute, permitted the government to use the facilities of the hospital for the Study. The PHS correspondence files indicate that surgeon general Hugh Cumming himself appealed for Dr. Moton’s support, stressing the value to be gained from the research and the necessity of having the assistance of the doctors at Andrew Memorial Hospital.

      A final group needing to be solicited for approval was the private physicians in the county. At that time, there were nine white and one African American physicians in private practice. According to PHS files, Dr. D. C. Gill, director of the state Bureau of Preventable Diseases, met on behalf of the PHS with the members of the Macon County Board of Health, the local medical association (in this period of segregation, the sole African American physician in the county was not allowed to be a member of the association). Gill explained the project to the association and the private doctors agreed to support it.

      Meanwhile, Dr. Raymond Vonderlehr had been named by Clark as the Public Health Service officer who would actually be in charge of the Study. Like Clark, Vonderlehr was a Southerner (Virginia). He was in his mid-thirties at the time and had been with the PHS for a little less than a decade. He was well-respected by Clark and his other superiors and had an extensive background in syphilology, including cardiovascular syphilis.

      Joining Vonderlehr to help launch the project was Dr. O. C. Wenger, the Director of the PHS Venereal Disease Clinic in Arkansas. Wenger had supervised the 1929 surveys in Mississippi that led to the Rosenwald surveys the next year, and he had accompanied Clark to Alabama in September 1932 to secure the cooperation of the Alabama Board of Health and Tuskegee Institute. He was certainly familiar with the goals of the project and well-qualified for the field work that was about to begin.

      The PHS officials were interested in hiring an African American nurse for the project. Dr. Dibble recommended Eunice Rivers, who at that time was a supervisor of night nurses at Andrew Memorial Hospital. More than any other single person, Nurse Rivers was to personify the Tuskegee Syphilis Study to the six hundred men who became involved in it. For the purpose of the study, Nurse Rivers was assigned as a scientific assistant to Venereal Disease Program of the Macon County Health Department.

      In any event, by October 1932, the U.S. Public Health Service, with the cooperation of public health agencies in Alabama, and the apparent approval of the local, state, and national medical establishments for treatment of venereal disease, was ready to embark upon a program which would not treat syphilis in African American males, in order to observe the effects of untreated syphilis. Thus the Tuskegee Syphilis Study was launched. It was to continue for forty years.

      Note

1 - The information in this chapter is drawn largely from documents and information discovered during the legal research for the court case filed in 1973.

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       The Study, 1932–1972