“Normal Exposure” and Inoculation Syphilis: A PHS “Tuskegee” Doctor in Guatemala, 1946–1948

Journal of Policy History

Volumn 23, Issue 1, 2011, Pages 6-28

  Reverby, Susan M ^a  

^a WELLESLEY COLLEGE   (United States)

Author keywords

[No Author keywords available]

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EID: 79952032373     PISSN: 08980306     EISSN: 15284190     Source Type: Journal    
DOI: 10.1017/S0898030610000291     Document Type: Article

References (82)

1. Susan M. Reverby, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (Chapel Hill, 2009), 187-203.
2. There was also a debate well into the 1950s over whether penicillin should be given to those in the late latent stage of the disease. The standard of care was to decide this on an individual basis. This was not done in the study. The issue of whether any of the wives/sexual partners of the men were treated is still controversial. The now-available medical records (in the Southeast Regional National Archives in Morrow, Georgia) have the wives’ treatment status blacked out to protect their privacy, making it impossible to evaluate claims that there had been some treatment for wives found to be in the contagious stage. When the study ended, the PHS agreed to treat twenty-two wives, seventeen children, and two grandchildren who tested positive for syphilis. For more on how this was determined, see Susan M. Reverby, “The ‘Tuskegee’ Syphilis Study as a ‘Site of Memory,’” in The Search for the “Legacy” of the U.S. Public Health Syphilis Study at Tuskegee, ed. Ralph Katz and Rueben Warren (Lanham, Md. forthcoming).
3. James H. Jones, Bad Blood, rev. ed. (New York, 1993)
4. Susan M. Reverby, ed. Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study (Chapel Hill, 2000)
5. Reverby, Examining Tuskegee.
6. Alessandro Portelli, The Death of Luigi Trastulli and Other Stories (Albany, N.Y. 1990), 2.
7. Sociologist Tamotsu Shibutani, quoted in Whispers on the Color Line: Rumor and Race in America, ed. Patricia Turner and Gary Alan Fine (Berkeley and Los Angeles, 2004), 58-59.
8. Susan M. Reverby, “More than Fact and Fiction: Cultural Memory and the Tuskegee Syphilis Study,” Hastings Center Report 31 (September–October 2001): 22-28.
9. For various versions of this argument, see Thomas G. Benedek and Jonathan Erlen, “The Scientific Environment of the Tuskegee Study of Syphilis, 1920–1960,” Perspectives in Biology and Medicine 45 (Autumn 1999): 1-30
10. Richard Shweder, “Tuskegee Re-Examined,” Spiked online, www.spiked-online.com, 8 January 2004
11. Robert W. White, “Unraveling the Tuskegee Study of Untreated Syphilis,” Archives of Internal Medicine 160 (13 March 2000): 585-98.
12. Joan Sherwood, “Syphilization: Human Experimentation in the Search for a Syphilis Vaccine in the Nineteenth Century,” Journal of the History of Medicine 54 (July 1999): 364-86
13. Susan E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore, 1995).
14. Marcos Cueto, The Value of Health: A History of the Pan American Health Organization (Washington, D.C. 2007)
15. argues that the immediate postwar era was a major point in “inter-American” public health exchanges; see also Pan American Sanitary Bureau, The Pan American Sanitary Bureau: A History of Its Organization, Function, and Activities (Mexico City, 1946).
16. On the expansion of social welfare during the liberalization of politics in Guatemala between World War II and before the CIA-backed coup in 1954, see Susanne Jonas, The Battle for Guatemala: Rebels, Death Squads, and U.S. Power (Boulder, 1991), 21-40.
17. Jan Ackerman, “Obituary: John Charles Cutler/Pioneer in Preventing Sexual Diseases,” Pittsburgh Post-Gazette, 12 February 2003, www.post-gazette.com.
18. For more on Cutler's career, see Reverby, Examining Tuskegee, 144–51.
19. “The Deadly Deception,” NOVA. Videotape, PBS. Directed by Denise DiIanni. Boston: WGBH Educational Foundation Films for the Humanities and Sciences, 1993.
20. Nancy Tomes, “Introduction: Imperial Medicine and Public Health,” in Colonial Crucible: Empire in the Making of the Modern American State, ed. Alfred W. McCoy and Francisco A. Scarano (Madison, 2009), 273-76.
21. Harry F. Dowling, Fighting Infection: Conquests of the Twentieth Century (Cambridge, Mass. 1977), 125-57
22. John Parascandola, Sex, Sin, and Science (New York, 2008).
23. Quoted in Reverby, Examining Tuskegee, 139. The leftover questions about the biology of syphilis have resurfaced with those who think there is a connection between untreated syphilis and HIV/AIDS. See Harris L. Coulter, AIDS and Syphilis—The Hidden Link (Berkeley and Los Angeles, 1993)
24. Coleman Jones, “Challenging Dissident Dogma: The Role of Infectious Co-Factors in AIDS,” http://breakfornews.com/aidsmyth./news/000529syphilisdebate.htm (accessed 19 March 2010).
25. John C. Cutler, “Current Concepts of Prophylaxis,” Bulletin of the New York Academy of Medicine 52 (October 1976): 866-96.
26. For the counterview to the position on prophylaxis taken by Cutler and the PHS, see Joseph Earle Moore, The Modern Treatment of Syphilis, 2nd ed. (Springfield, Ill. 1943), 564-67.
27. On tensions between the PHS doctors and Moore, see John F. Mahoney to John C. Cutler, 19 April 1948, Box 1, Folder 13, John C. Cutler Papers, University Archives, University of Pittsburgh, Pittsburgh, Pa. (hereafter, Cutler Papers).
28. Inoculum was both cultured and taken from the penis of one infected man and put into the penis of another. See John F. Mahoney et al. “Experimental Gonococcic Urethritis in Human Volunteers,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 30 (January 1946): 1-39.
29. For more on the policy debate over the Terre Haute research, see Harry M. Marks, The Progress of Experiment (New York, 1997), 100-105.
30. On a revived interest in prison research, see Institute of Medicine, Ethical Considerations for Research Involving Prisoners (Washington, D.C. 2006)
31. Barron H. Lerner, “Subjects or Objects? Prisoners and Human Experimentation,” New England Journal of Medicine 356 (3 May 2007): 1806-7.
32. Jeanne L. Brand, “The U.S. Public Health Service and International Health,” Bulletin of the History of Medicine 63 (Winter 1989): 582-83.
33. Hugh S. Cumming, who had been the surgeon general when the “Tuskegee” Study began, served as the director of the Pan American Sanitary Bureau from 1936 (when he left the PHS) to 1947. See Ralph Chester Williams, The United States Public Health Service, 1798 to 1950 (Washington, D.C. 1951), 446.
34. Marcos Cueto, “Introduction,” in Missionaries of Science: The Rockefeller Foundation and Latin America (Bloomington, 1994), xiii.
35. See Jonas, Battle for Guatemala
36. Stephen Kinzer and Stephen Schlesinger, Bitter Fruit: The Story of the American Coup in Guatemala (Cambridge, Mass. 1999)
37. David McBride, Missions for Science (New Brunswick, 2002).
38. George Cheever Shattuck, “Syphilis and Yaws in Guatemala,” in A Medical Survey of the Republic of Guatemala, ed. George Cheever Shattuck (Washington, D.C. 1938), 142.
39. Shattuck also summarizes medical beliefs about racial differences in the virility and existence of syphilis. See “Appendix B, The Clinical Case of Syphilis in Various Races,”153–56; see also George Cheever Shattuck, “Lesions of Syphilis in American Indians,” American Journal of Tropical Medicine 18 (1938): 577-86.
40. On the use of race to matter and not matter, see Reverby, Examining Tuskegee.
41. See also Chester North Frazier and Li Hung-Chiung, Racial Variations in Immunity to Syphilis: A Study of the Disease in the Chinese, White, and Negro Races (Chicago, 1948).
42. “Untitled Report,” 24 February 1954, Folder 1, Box 1, Cutler Papers.
43. Sherwood, “Syphilization.”
44. On the search for a better prophylactic, see R. C. Arnold and John C. Cutler, “Experimental Studies to Develop Local Prophylactic Agents Against Syphilis,” British Journal of Venereal Diseases 32 (1956): 34-36.
45. “Untitled Report,” 6.
46. Untitled Report 7.
47. Sacha Levitan et al. “Clinical and Serologic Studies with Reference to Syphilis in Guatemala, Central America,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 36 (July 1952): 379.
48. American Journal of Syphilis, Gonorrhea, and Venereal Diseases 5, and Levitan et al. “Clinical and Serologic Studies,” 379.
49. Levitan et al. “Clinical and Serologic Studies,” 387. They argued that “significantly higher percentages of positive and doubtful reactions were obtained from Kahn and Mazzini tests than with the Kolmer test and the VDRL slide test.” Today, syphilis serological diagnosis requires a reactive nontreponemal test confirmed with a treponemal test.
50. Clinical and Serologic Studies 25.
51. Clinical and Serologic Studies 32.
52. For a discussion of the various strains of the disease used, see “Part II Final Syphilis Report,” p. 1-5, Box 1, Folder 2, Cutler Papers.
53. “Untitled Report,” 48. See also instructions from R. C. Arnold to John C. Cutler, 21 July 1947. On the history of various kinds of inoculation techniques, see Harold J. Magnuson et al. “Inoculation Syphilis in Human Volunteers,” Medicine 35 (February 1956): 33-82.
54. On the difference with gonorrhea inoculation, see Mahoney et al. “Experimental Gonococcic Urethritis in Human Volunteers.” Cutler was a co-author on both of these articles. Prison studies seem to use the term “human volunteers” in their titles.
55. Cutler to Mahoney, 27 December 1947.
56. Cutler to Arnold, 5 June 1947.
57. Cutler to Arnold, 27 June 1947.
58. Saul Benison, Tom Rivers: Reflections on a Life in Medicine and Science, An Oral History Memoir prepared by Saul Benison (Cambridge, 1967), 187.
59. John C. Cutler, “An Experimental Resurvey of the Basic Factors Concerned in Prophylaxis in Syphilis,” unpublished typescript, Box 1, Folder 9, Cutler Papers.
60. “Part III Final Syphilis Report,” p. 25, Box 1, Folder 3, Cutler Papers.
61. “Untitled Report,” 34–39
62. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (New York, 1987, 1993).
63. By 1950, the VDRL stopped all research on chemical prophylaxis. See John C. Cutler, “Current Concepts of Prophylaxis,” Bulletin of the New York Academy of Medicine 52 (October 1976): 886-96.
64. Lederer, Subjected to Science, 82–87, on Hideyo Noguchi's controversial syphilis experiments at the Rockefeller Institute in New York in 1911.
65. Jussi Niemela, “What Puts the ‘Yuck’ in the ‘Yuck Factor,” Bioethics, online 25 February 2010, www3.interscience.wiley.com (accessed 25 March 2010).
66. Sacha Levitan et al. “Clinical and Serologic Studies with Reference to Syphilis in Guatemala Central America I,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 36 (July 1952): 379-87
67. John C. Cutler et al. “Studies on the Comparative Behavior of Various Serologic Tests for Syphilis II,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 36 (November 1952): 533–44
68. Joseph Portnoy et al. “Clinical and Serologic Studies with Reference to Syphilis in Guatemala, Central American III,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 36 (November 1952): 566–70.
69. Juan Funes et al. “Serologic and Clinical Studies in Syphilis in Guatemala, Central America, II,” Boletín de la Oficina Sanitaria Panamericana 34 (January 1953): 14-18.
70. Magnuson et al. “Inoculation Syphilis.” One of the other physicians on this project was Sidney Olansky, who had directed the work in Tuskegee in the 1950s.
71. For more on Olansky and Cutler, see Reverby, Examining Tuskegee.
72. See Warwick Anderson, “Pacific Crossings: Imperial Logics in United States’ Public Health Programs,” in Colonial Crucible, ed. McCoy and Scarano, 277-87.
73. There is a huge bioethics and policy debate on this issue. See, for example, Jennifer S. Hawkins and Ezekiel J. Emanuel, eds. Exploitation and Developing Countries: The Ethics of Clinical Research (Princeton, 2008)
74. Ruth Macklin, Double Standards in Medical Research in Developing Countries (Cambridge, 2004)
75. Reverby, Examining Tuskegee, 228–30.
76. The issue of human-subject protection is even more relevant now as the percentage of foreign trials for drugs in the United States has become more common. See Gardiner Harris, “Concern over Foreign Trials for Drugs Sold in U.S.” New York Times, 21 June 2010, A14
77. Adriana Petryna, When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (Princeton, 2009).
78. For more details, see Susan M. Reverby, “After the Media Frenzy: Preventing Another ‘Guatemala,’” Bioethics Forum: A Service of the Hastings Center, 6 October 2010, http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4919&blogid=140 (accessed 6 October 2010).
79. John M. Douglas, “Full Centers for Disease Control and Prevention Report on the 1946–1948 U.S. Public Health Service Sexually Transmitted Disease (STD) Inoculation Study,” http://www.hhs.gov/1946inoculationstudy (accessed 15 October 2010).
80. “Joint Statement by Secretaries Clinton and Sebelius on a 1946–1948 Study,” http://www.hhs.gov/1946inoculationstudy (accessed 15 October 2010).
81. “Read-out of the President's Call with Guatemalan President Colom,” http://www.hhs.gov/1946inoculationstudy (accessed 15 October 2010).
82. Thomas R. Frieden and Francis S. Collins, “Intentional Infection of Vulnerable Populations in 1946–1948,” Journal of the American Medical Association, published online 11 October 2010. doi:10.1001/jama.2010.1554 and http://www.hhs.gov/1946inoculationstudy.