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Hastings Center Report

Volumn 8, Issue 6, 1978, Pages 21-29

Racism and Research: The Case of the Tuskegee Syphilis Study

(1) BRANDT, ALLAN M a

a NONE

Author keywords

[No Author keywords available]

Indexed keywords

PENICILLIN DERIVATIVE;

ARTICLE; ATTITUDE; GOVERNMENT; HISTORICAL ASPECTS; HUMAN; HUMAN EXPERIMENT; INFORMED CONSENT; MALE; MEDICAL ETHICS; MORALITY; MORTALITY; NEGRO; PHYSICIAN; PUBLIC HEALTH SERVICE; SOCIAL DISCRIMINATION; SOCIAL PSYCHOLOGY; SYPHILIS; TREATMENT WITHDRAWAL; TUSKEGEE SYPHILIS STUDY; UNITED STATES;

FEDERAL GOVERNMENT; HISTORICAL ASPECTS; MALES; SOCIAL DISCRIMINATION; TUSKEGEE SYPHILIS STUDY;

ALABAMA; ATTITUDE OF HEALTH PERSONNEL; BLACKS; ETHICS, MEDICAL; HUMAN; HUMAN EXPERIMENTATION; INFORMED CONSENT; MALE; MORALS; PENICILLINS; PHYSICIANS; PREJUDICE; SYPHILIS; SYPHILIS, LATENT; UNITED STATES; UNITED STATES PUBLIC HEALTH SERVICE; WITHHOLDING TREATMENT;

EID: 0018108013 PISSN: 00930334 EISSN: 1552146X Source Type: Journal
DOI: 10.2307/3561468 Document Type: Article

Times cited : (443)

References (90)

1
- 84980220393
- The best general accounts of the study are “The 40‐Year Death Watch,”Medical World News
- (1972) , pp. 15-17

2
- 84980306376
- “Why 430 Blacks with Syphilis Went Uncured for 40 Years,” Detroit Free Press. The mortality figure is based on a published report of the study which appeared in 1955. See Jesse J. Peters, James H. Peers, Sidney Olansky, John C. Cutler, and Geraldine Gleeson, “Untreated Syphilis in the Male Negro: Pathologic Findings in Syphilitic and Nonsyphilitic Patients,” Journal of Chronic Diseases 1 (February 1955), 127–48. The article estimated that 30.4 percent of the untreated men would die from syphilitic lesions.
- (1972)
- Dolores¹

3
- 84951030945
- (Washington, D.C.:, GPO). (Hereafter, HEW Final Report).
- (1973) Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel, Department of Health, Education, and Welfare

4
- 84980283550
- See George M. Frederickson
- (New York:, Harper and Row,. Also, John H. Haller, Outcasts From Evolution, Urbana, Ill.: University of Illinois Press, 1971), pp. 40–68
- (1971) The Black Image in the White Mind , pp. 228-255

5
- 84980220389
- Frederickson

6
- 84980307624
- See also J. A. Rodgers, “The Effect of Freedom upon the Psychological Development of the Negro,” Proceedings of the American Medico‐Psychological Association 7 (1900), 88–99. “From the most healthy race in the country forty years ago,” concluded Dr. Henry McHatton, “he is today the most diseased.” “The Sexual Status of the Negro—Past and Present,” American Journal of Dermatology and Genito‐Urinary Diseases 10 (January 1906), 7–9
- (1903) Atlanta Journal-Record of Medicine , vol.5 , pp. 287-288

7
- 84889465656
- The Negro Problem from the Physician's Point of View
- See also, “Racial Anatomical Peculiarities,” New York Medical Journal 63 (April 1896), 500–01
- (1903) Atlanta Journal-Record of Medicine , vol.5 , pp. 461
- English, W.T.¹

8
- 0347271025
- The Race Problem
- p. 501, Also
- (1903) Medicine (Detroit) , vol.9 , pp. 338-343
- Bacon¹

9
- 0342393314
- Syphilis in the American Negro
- For deeper background into the historical relationship of racism and sexuality see Winthrop D. Jordan, White Over Black (Chapel Hill: University of North Carolina Press, 1968; Pelican Books, 1969), pp. 32–40
- (1914) Journal of the American Medical Association , vol.63 , pp. 463
- Hazen, H.H.¹

10
- 27544464024
- Racial Peculiarities: A Cause of the Prevalence of Syphilis in Negroes
- (1906) American Journal of Dermatology and Genito-Urinary Diseases , vol.10 , pp. 277
- David¹

11
- 84980225158
- English

12
- 33646496873
- The Negro as a Distinct Ethnic Factor in Civilization
- See also, Thomas W. Murrell, “Syphilis in the American Negro,” Journal of the American Medical Association 54 (March 12, 1910), 848
- (1903) Medicine (Detroit) , vol.9 , pp. 424
- Lee¹

13
- 84995654612
- The editorial added: “The badge of disgrace and emasculation might be branded upon the face or forehead, as a warning, in the form of an ‘R,’ emblematic of the crime for which this punishment was and will be inflicted.”
- (1906) Atlanta Journal-Record of Medicine , vol.8 , pp. 457

14
- 84980220364
- The Future of the Negro from the Standpoint of the Southern Physician
- Other articles on the prevalence of venereal disease among blacks are: H. L. McNeil, “Syphilis in the Southern Negro,” Journal of the American Medical Association 67 (September 30, 1916), 1001–04; Ernest Philip Boas, “The Relative Prevalence of Syphilis Among Negroes and Whites,” Social Hygiene 1 (September 1915), 610–16. Doctors went to considerable trouble to distinguish the morbidity and mortality of various diseases among blacks and whites. See, for example, Marion M. Torchia, “Tuberculosis Among American Negroes: Medical Research on a Racial Disease, 1830–1950,” Journal of the History of Medicine and Allied Sciences 32 (July 1977), 252–79
- (1902) Alabama Medical Journal , vol.14 , pp. 62
- Searle¹

15
- 84980234057
- Syphilis in the Negro: Its Bearing on the Race Problem
- (1906) American Journal of Dermatology and Genito-Urinary Diseases , vol.10 , pp. 307
- Thomas¹

16
- 84980220378
- “Even among the educated, only a very few will carry out the most elementary instructions as to personal hygiene. One thing you cannot do, and that is to convince the negro that he has a disease that he cannot see or feel. This is due to lack of concentration rather than lack of faith; even if he does believe, he does not care; a child of fancy, the sensations of the passing hour are his only guides to the future. Murrell, “Syphilis in the American Negro,” p.

17
- 84980284867
- (1903) Atlanta Journal-Record of Medicine , vol.5 , pp. 288

18
- 84980203428
- “Syphilis in the Negro; Its Bearing on the Race Problem,” p.

19
- 84980199553
- “The anatomical and physiological conditions of the African must be understood, his place in the anthropological scale realized, and his biological basis accepted as being unchangeable by man, before we shall be able to govern his natural uncontrollable sexual passions.” See, “As Ye Sow That Shall Ye Also Reap
- (1899) Atlanta Journal-Record of Medicine , vol.1 , pp. 266

20
- 84980199561
- Chicago:, Julius Rosenwald Fund,. Approximately 35 percent of the inhabitants of Macon County who were examined were found to be syphilitic
- (1932) The Control of Syphilis in Southern Rural Areas , pp. 53-58
- Taliaferro¹

21
- 84951291016
- (New York:, Dover, 1957), pp.
- (1865) An Introduction to the Study of Experimental Medicine , pp. 5-26
- Claude¹

22
- 84980203467
- Taliaferro Clark to,. Records of the USPHS Venereal Disease Division, Record Group 90, Box 239, National Archives, Washington National Record Center, Suitland, Maryland. (Hereafter, NA‐WNRC). Materials in this collection which relate to the early history of the study were apparently never consulted by the HEW investigation. Included are letters, reports, and memoranda written by the physicians engaged in the study.
- (1932)
- Davis, M.M.¹

23
- 84980290361
- H. S. Cumming to R. R. Moton, NA‐WNRC.
- (1932)

24
- 84980218451
- Clark to Davis, NA‐WNRC.
- (1932)

25
- 84980283607
- Cumming to Moton, NA‐WNRC.
- (1932)

26
- 84980213030
- Bruusgaard was able to locate 309 living patients, as well as records from 164 who were diseased. His findings were published as “Ueber das Schicksal der nicht specifizch behandelten Luetiken
- The best discussion of the Boeck‐Bruusgaard data is E. Gurney Clark and Niels Danbolt, “The Oslo Study of the Natural History of Untreated Syphilis,” Journal of Chronic Diseases 2 (September 1955), 311–44
- (1929) Archives of Dermatology and Syphilis , vol.157 , pp. 309-332

27
- 0004250552
- Baltimore:, Charles C. Thomas
- (1933) The Modern Treatment of Syphilis , pp. 24

28
- 84980213040
- Moore, pp. 231–47; see also John H. Stokes
- Philadelphia:, W. B. Saunders
- (1928) Modern Clinical Syphilology , pp. 231-239

29
- 84980304189
- Moore

30
- 84980234128
- Moore

31
- 33745536763
- Cooperative Clinical Studies in the Treatment of Syphilis: Latent Syphilis
- The authors also concluded that the latently syphilitic were potential carriers of the disease, thus meriting treatment
- (1932) Venereal Disease Information , vol.13 , pp. 351
- Moore, J.E.¹ Cole, H.N.² O'Leary, P.A.³ Stokes, J.H.⁴ Wile, U.J.⁵ Clark, T.⁶ Parran, T.⁷ Usilton, J.H.⁸

32
- 84980307628
- Clark to Paul A. O'Leary, NA‐WNRC. O'Leary, of the Mayo Clinic, misunderstood the design of the study, replying: “The investigation which you are planning in Alabama is indeed an intriguing one, particularly because of the opportunity it affords of observing treatment in a previously untreated group. I assure you such a study is of interest to me, and I shall look forward to its report in the future.” O'Leary to Clark, October 3, 1932, NA‐WNRC.
- (1932)

33
- 84980234119
- “Latent Syphilis,” unpublished typescript ,. American Social Hygiene Association Papers, Social Welfare History Archives Center, University of Minnesota, Minneapolis, Minnesota
- Earle¹

34
- 84980207324
- Moore to Clark, NA‐WNRC. Moore had written in his textbook, “In late syphilis the negro is particularly prone to the development of bone or cardiovascular lesions.” See Moore, The Modern Treatment of Syphilis
- (1932) , pp. 35

35
- 84980203463
- O. C. Wenger to Clark, NA‐WNRC.
- (1932)

36
- 84980290331
- Wenger to Clark, NA‐WNRC.
- (1932)

37
- 84980283581
- Clark Memorandum, NA‐WNRC. See also, Clark to Davis, October 29, 1932, NA‐WNRC.
- (1932)

38
- 84980234088
- “You will observe that our plan has nothing to do with treatment. It is purely a diagnostic procedure carried out to determine what has happened to the syphilitic Negro who has had no treatment. Clark to Paul A. O'Leary, NA‐WNRC.
- (1932)
- Clark¹

39
- 84980255386
- D. G. Gill to O. C. Wenger, NA‐WNRC.
- (1932)

40
- 84980234100
- Clark to Vonderlehr, NA‐WNRC.
- (1933)

41
- 84980283568
- Vonderlehr to Clark, NA‐WNRC.
- (1933)

42
- 84980283645
- Vonderlehr to Clark, NA‐WNRC. Also, Vonderlehr to Clark, February 6, 1933, NA‐WNRC.
- (1932)

43
- 84980207366
- Clark to Vonderlehr, NA‐WNRC.
- (1933)

44
- 84980199594
- “The reason treatment was given to many of these men was twofold: First, when the study was started in the fall of 1932, no plans had been made for its continuation and a few of the patients were treated before we fully realized the need for continuing the project on a permanent basis. Second it was difficult to hold the interest of the group of Negroes in Macon County unless some treatment was given. Vonderlehr to Austin V. Diebert, December 5, 1938, Tuskegee Syphilis Study Ad Hoc Advisory Panel Papers, Box 1, National Library of Medicine, Bethesda, Maryland. (Hereafter, TSS‐NLM). This collection contains the materials assembled by the HEW investigation in 1972.

45
- 84980244800
- Vonderlehr to Clark, NA‐WNRC.
- (1933)

46
- 84980298109
- H. S. Cumming to J. N. Baker, NA‐WNRC.
- (1933)

47
- 84980217919
- January 22, 1933;, NA‐WNRC.
- (1933)

48
- 84980255432
- Vonderlehr to Clark, NA‐WNRC.
- (1933)

49
- 84980230305
- Clark to Moore, NA‐WNRC.
- (1933)

50
- 84980213099
- “Letter to Subjects,” NA‐WNRC.

51
- 84980230312
- Vonderlehr to Clark, NA‐WNRC. See also, Vonderlehr to Wenger, July 18, 1933, NA‐WNRC.
- (1933)

52
- 84980218490
- Wenger to Vonderlehr, NA‐WNRC. The italics are Wenger's.
- (1933)

53
- 84980222867
- Cumming to Moton, NA‐WNRC.
- (1933)

54
- 84980298093
- Wenger to Vonderlehr, NA‐WNRC.
- (1933)

55
- 84980225587
- Vonderlehr to Murray Smith, NA‐WNRC.
- (1933)

56
- 84980306401
- Wenger to Vonderlehr, NA‐WNRC.
- (1933)

57
- 84980213058
- Vonderlehr to Wenger, NA‐WNRC. Controls were given salicylates.
- (1933)

58
- 84980218475
- Untreated Syphilis in the Male Negro, III
- (1946) Venereal Disease Information , vol.27 , pp. 301-314
- Austin¹ Martha²

59
- 0000745689
- Stanley Schuman, Lloyd Simpson, Sidney Olansky, “Twenty‐Years of Followup Experience In a Long‐Range Medical Study
- In this article Nurse Rivers explains her role in the experiment. She wrote: “Because of the low educational status of the majority of the patients, it was impossible to appeal to them from a purely scientific approach. Therefore, various methods were used to maintain their interest. Free medicines, burial assistance or insurance (the project being referred to as ‘Miss Rivers’ Lodge'), free hot meals on the days of examination, transportation to and from the hospital, and an opportunity to stop in town on the return trip to shop or visit with their friends on the streets all helped. In spite of these attractions, there were some who refused their examinations because they were not sick and did not see that they were being benefitted.” (p. 393)
- (1953) Public Health Reports , vol.68 , pp. 391-395

60
- 84980283623
- Austin V. Diebert to Raymond Vonderlehr, TSS‐NLM, Box 1.
- (1939)

61
- 84980255420
- Murray Smith to Subjects, TSS‐NLM, Box 1. See also, Sidney Olansky to John C. Cutler, November 6, 1951, TSS‐NLM, Box 2.
- (1938)

62
- 84980199645
- See Cumming to Davis, NA‐WNRC. This money was usually divided between the undertaker, pathologist, and hospital. Lloyd Isaacs to Raymond Vonderlehr, April 23, 1940, TSS‐NLM, Box 1.
- (1934)

63
- 0001761396
- Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study
- (1955) Journal of Chronic Diseases , vol.2 , pp. 555
- Stanley¹ Sidney² Eunice³ Smith, C.A.⁴ Dorothy⁵

64
- 31044441218
- Untreated Syphilis in the Male Negro
- (1936) Venereal Disease Information , vol.17 , pp. 262
- Vonderlehr, R.A.¹ Taliaferro²

65
- 0001788174
- Untreated Syphilis in the Male Negro: II. Mortality During 12 Years of Observation
- (1946) Venereal Disease Information , vol.27 , pp. 34-38
- Heller, J.R.¹ Bruyere, P.T.²

66
- 0001559310
- Untreated Syphilis in the Male Negro: Pathologic Findings in Syphilitic and Non‐Syphilitic Patients
- (1955) Journal of Chronic Diseases , vol.1 , pp. 127-148
- Jesse¹ James² Sidney³ John⁴ Geraldine⁵

67
- 3242809816
- Untreated Syphilis in the Male Negro, X. Twenty Years of Clinical Observation of Untreated Syphilitic and Presumably Nonsyphilitic Groups
- (1956) Journal of Chronic Diseases , vol.4 , pp. 184
- Sidney¹ Stanley² Jesse³ Smith, C.A.⁴ Dorothy⁵

68
- 84980199626
- “Untreated Syphilis in Male Negro,” Unpublished typescript,. Tuskegee Files, Center for Disease Control, Atlanta, Georgia. (Hereafter TF‐CDC)
- (1950) , pp. 3
- Wenger, O.C.¹

69
- 0016632840
- Proper Uses and Abuses of the Health Care Delivery System for Minorities with Special Reference to the Tuskegee Syphilis Study
- (1975) Journal of the National Medical Association , vol.67 , pp. 83
- Vernal¹

70
- 84980281165
- See for example, Vonderlehr to B. W. Booth, ; Vonderlehr to E. R. Lett, November 20, 1933, NA‐WNRC.
- (1934)

71
- 84980199648
- “Transcript of Proceedings—Tuskegee Syphilis Ad Hoc Advisory Panel,”, unpublished typescript, TSS‐NLM, Box 1.
- (1973)

72
- 84980213129
- Raymond Vonderlehr to Murray Smith, ; and Smith to Vonderlehr, June 8, 1942, TSS‐NLM, Box 1.
- (1942)

73
- 0001761396
- Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study
- (1955) Journal of Chronic Diseases , vol.2 , pp. 550-553
- Stanley¹ Sidney² Eunice³ Smith, C.A.⁴ Dorothy⁵

74
- 84980281145
- Raymond Vonderlehr to Stanley H. Schuman,. TSS‐NLM, Box 2.
- (1952)

75
- 84980199636
- Schuman¹

76
- 84980199635
- “Minutes, April 5, 1965” unpublished typescript, TSS‐NLM, Box 1.

77
- 84980307675
- “Tuskegee Ad Hoc Committee Meeting—Minutes, February 6, 1969,” TF‐CDC.

78
- 84980207781
- James B. Lucas to William J. Brown, TF‐CDC.
- (1970)

79
- 84980281135
- Elizabeth M. Kennebrew to Arnold C. Schroeter, TSS‐NLM, Box 1.
- (1971)

80
- 84980244795
- See Medical Tribune, (; and Report on HEW's Tuskegee Report, Medical World News, September 14, 1973), pp. 57–58
- (1972) , pp. 1-20

81
- 84980199615
- HEW Final Report

82
- 84980199616
- The notable exception is Jay Katz's eloquent “Reservations About the Panel Report on Charge 1,” HEW Final Report

83
- 84980245307
- HEW Final Report

84
- 84980222917
- HEW Final Report

85
- 0015413532
- The Tuskegee Study of Untreated Syphilis
- and “Final Report on the Tuskegee Syphilis Study,'” Southern Medical Journal 67 (November 1974), 1349–53
- (1972) Southern Medical Journal , vol.65 , pp. 1247-1251
- Kampmeier, R.H.¹

86
- 84980218503
- “The Tuskegee Study in Historical Perspective,” unpublished typescript, TSS‐NLM; see also “Treponemes and Tuskegee,” Lancet (June 23, 1973), p. 1438; and Louis Lasagna, The VD Epidemic (Philadelphia: Temple University Press, 1975), pp. 64–66.
- Leonard¹

87
- 84980281416
- Quoted in “Debate Revives on the PHS Study,” Medical World News
- (1974) , pp. 37

88
- 84980226267
- NA‐WNRC; quoted in Medical Tribune (August 23, 1972), p.
- (1933) Heller to Vonderlehr , pp. 14

89
- 84980218521
- The fact that members of the control group were placed in the test group when they became syphilitic proves that at least some infectious men were denied treatment.

90
- 84980298373
- Basic human rights may be compromised. Hans Jonas has clearly explicated the problem in his “Philosophical Reflections on Experimentation
- As Jonas writes: “If the properties we adduced as the particular qualifications of the members of the scientific fraternity itself are taken as general criteria of selection, then one should look for additional subjects where a maximum of identification, understanding, and spontaneity can be expected—that is, among the most highly motivated, the most highly educated, and the least ‘captive’ members of the community.”
- (1969) Daedalus , vol.98 , pp. 234-237

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