Examining Tuskegee

Examining Tuskegee: The Infamous Syphilis Study and Its Legacy

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    Examining Tuskegee
    Book Description:

    The forty-year "Tuskegee" Syphilis Study has becometheAmerican metaphor for medical racism, government malfeasance, and physician arrogance. The subject of histories, films, rumors, and political slogans, it received an official federal apology from President Bill Clinton in a White House ceremony.Susan M. Reverby offers a comprehensive analysis of the notorious study of untreated syphilis, which took place in and around Tuskegee, Alabama, from the 1930s through the 1970s. The study involved hundreds of African American men, most of whom were told by doctors from the U.S. Public Health Service that they were being treated, not just watched, for their late-stage syphilis. Reverby examines the study and its aftermath from multiple perspectives to explain what happened and why the study has such power in our collective memory. She follows the study's repercussions in facts and fictions.Reverby highlights the many uncertainties that dogged the study during its four decades and explores the newly available medical records. She uncovers the different ways it was understood by the men, their families, and health care professionals, ultimately revising conventional wisdom on the study.Writing with rigor and clarity, Reverby illuminates the events and aftermath of the study and sheds light on the complex knot of trust, betrayal, and belief that keeps this study alive in our cultural and political lives.

    eISBN: 978-1-4696-0532-6
    Subjects: Sociology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xvi)
  4. Introduction Race, Medical Uncertainty, and American Culture
    (pp. 1-10)

    “He who knows syphilis, knows medicine,” famed early twentiethcentury Johns Hopkins physician Sir William Osler is often quoted as saying.¹ The contemporary adage would be different: “Those who know ‘Tuskegee’ know racism in medicine and injustice.” Yet these simple maxims belie their connected longer versions and not-so-simple truths. A twentieth-century medical research study of African American men with the sexually transmitted disease of syphilis, in which the hundreds involved did not know that treatment was supposedly withheld, has led to many stories where conceptions of race, uncertainties in medicine, mistrust of doctors, and the power the state intertwine.² This book...


    • 1 Historical Contingencies Tuskegee Institute, the Public Health Service, & Syphilis
      (pp. 13-28)

      “Why us?” a family member of one of the men in the Study asked me at a meeting at the Shiloh Missionary Baptist Church in Notasulga, Alabama, just outside Tuskegee in 2007. The Study could perhaps have happened elsewhere. But, in many ways, the long-standing and complicated ties between Tuskegee Institute and the federal government over health care and disease in the black community provided the historical contingencies that made the Study possible, while only a disease as linked to sex and the black body and as widespread as syphilis could have brought them together for so long both in...

    • 2 Planned, Plotted, and Official The Study Begins
      (pp. 29-55)

      Macon County proved to be an ideal site for one of the Rosenwald Fund Demonstration Projects.¹ In 1930, the county was 82.4 percent black, spread over 650 square miles, representing what Taliaferro Clark, the PHS’s lead physician/researcher for the project and head of its Venereal Disease Division, labeled the “broad extremes in the development of the Negro race.”² Tuskegee Institute was presumed to represent the “best.” Much of the rest of the county’s black population, caught up in grinding rural poverty, seemed to be the “worst.”³

      Little health and education infrastructure to support the demonstration work existed—mainly a newly...

    • 3 Almost Undone The Study Continues
      (pp. 56-72)

      Even though the PHS secured the cooperation of the Macon County Health Department and Tuskegee Institute, the Study almost came undone over and over. Nothing in Macon County was simple. Even the southern climate worked against the PHS. Tissue samples arrived at its laboratories in poor condition. The men’s bodies were sometimes embalmed or had deteriorated before they made it to autopsy.¹ The great migration of black men and women out of the rural South that began in the interwar years threatened to undermine what was supposed to be a controlled environment and made follow-up difficult. Despite the assumption that...

    • 4 What Makes It Stop?
      (pp. 73-85)

      In November 1957, in the twenty-fifth year of the Study, the PHS held a meeting to discuss what should be done next. The last major roundup of the men had taken place in 1952–53, although the blood draws were happening yearly. Aware of some of the continued difficulties and the number of men who were leaving the area, both retesting and finding new incentives were discussed.¹ It was agreed that “free hot meals” would be provided and that the iron tonics and aspirins the men thought were treatments would continue to be given.²

      By the next year, each “patient”...

    • 5 Testimony The Public Story in the 1970s
      (pp. 86-108)

      From the day the first news story broke, the Study became notorious with “Tuskegee” its shorthand name. It came to light in the waning years of the civil rights movement when heated debates over the power and danger of medicine and the perfidiousness of government were commonplace. The story dropped onto a political landscape covered with concerns over sterilization abuse, birth control as black genocide, and approval of life-threatening drugs and attacks on insensitive medical institutions by feminists and civil rights activists.¹ Its very name “Tuskegee” reflected what was then seen as Booker T. Washington’s accommodationist racial politics.

      In the...

    • [Illustrations]
      (pp. None)

    • 6 What Happened to the Men and Their Families?
      (pp. 111-134)

      For Herman Shaw, it actually started with the rocks in Plano, Texas. Maybe if the Texas soil had been as good as the dirt in the Alabama Black Belt, his father would have kept the family there. In 1922, however, it became too hard to plow around the rocks. So as a young man and without the help of a map, Herman Shaw drove the family car for over four days back to his birthplace in Tallapoosa County, just north of Tuskegee. On a farm just outside of a town called Tallasee, they could grow cotton, corn, oats, and the...

    • 7 Why and Wherefore The Public Health Service Doctors
      (pp. 135-151)

      If the Study’s subjects and controls meld into one seemingly abject black man, the doctors become one amoral white man. Their military outlook and willingness to condemn others to death and debility is underscored by their formality in photographs, whether they are dressed in phS uniforms with epaulets and brass buttons or are standing ramrod straight in business suits. Knowing about the Study, it is easy to read into their faces and stances an ethical myopia and a distance from the lives of the black men in work jeans whom they dealt with.¹

      With so many different doctors in and...

    • 8 Triage and “Powerful Sympathizing” Eugene H. Dibble Jr.
      (pp. 152-166)

      “The results of this study will be sought after[,] the world over,” Tuskegee’s medical director, Dr. Eugene H. Dibble Jr., promised Tuskegee Institute leader Robert Russa Moton in 1932. Dibble’s words were to be prescient in ways he could not have imagined.¹ Certainly he did not expect the name of his beloved institution to be forever linked with ethical failure and racism in research. Dibble understood the ways of Tuskegee Institute to his core, and he used his position to cajole, organize, and provide for those under his care. As an indefatigable race man, Dibble devoted his life to improving...

    • 9 The Best Care Eunice Verdell Rivers Laurie
      (pp. 167-184)

      In the photograph, a dignified elderly woman stares out at the camera, her church-lady glasses framing a small face, her graying hair pulled back into a neat bun. Her arms are wrapped in front of her frail body; a gold medal rests comfortably on her chest.¹ Her “caring hands,” as the photographer labeled them, are long-fingered, veined, soft, and wrinkled. In 1984, twelve years after the Study entered national infamy, this photograph of Eunice Rivers (after her marriage she became Eunice Rivers Laurie, although many still called her “Nurse Rivers”), the Study’s public health nurse, was chosen for the poster...


    • 10 Bioethics, History, and the Study as Gospel
      (pp. 187-203)

      Physician Eugene Dibble thought that the Study would be remembered forever, but attorney Fred Gray worried that without the lawsuit somehow it and the men would be forgotten. They were both right. “Tuskegee” entered the American lexicon after 1972. The story had too many elements—a morally and physically loathsome disease, the powerful state, the sexualized black male body, white betrayal of black trust, seeming co-optation of the black middle class against “the folk,” experimentation, “mad” scientists, a “betraying” woman, ghoulish autopsies—for it to be erased forever from collective memory.¹ The Study, in all its intricate facticity, has not...

    • 11 The Court of Imagination
      (pp. 204-215)

      “Tuskegee,” throughout the 1990s and into the new century, evolved into a noun that reverberated through the evening news, films, music, primetime dramas, and Internet rumors. Uttered by characters onHouse, Law and Order, CSI, and Saturday Night Liveand by sonorous news anchors, it became the word for racism, experimentation, and government deceit.¹

      Questions of trust and experimentation demanded a cultural explanation.² In this process, the linkage of race and medical science played out within the paradigm of a racial melodrama that called upon the suffering black male body as a claim for rights.³ In the “court of the...

    • 12 The Political Spectacle of Blame and Apology
      (pp. 216-226)

      The Study seared its place into American culture through its appearance in the political realm, adding different kinds of visual events to the saga. With the election of liberal white southerner Bill Clinton to the presidency in 1992 and his efforts to speak about racial divides, it would be no surprise that the Study could gain political prominence. The debate over Clinton’s choice for surgeon general and then his willingness to extend a federal apology brought new media attention and scrutiny. The Study returned to its origins in the federal government, but in ways that provide insight into how differing...

  8. Epilogue The Difficulties of Treating Racism with “Tuskegee”
    (pp. 227-240)

    By the early twenty-first century, “Tuskegee” had become deeply embedded in the cultural life of the United States, and it had traveled across borders to be used in battles over drug studies. With the growing number of clinical trials in the Global South, medical racism and neocolonialism renewed the need for regulation. This time, in a trial for anti-hiv drugs in Uganda, “Tuskegee” came to be part of a new worldwide contestation. In this version, however, the CDC, the National Institutes of Health, and the African physicians who had agreed to these studies replied immediately, arguing something eerily similar to...

  9. APPENDIX A Chronology
    (pp. 241-248)
  10. APPENDIX B Key Participants’ Names
    (pp. 249-250)
  11. APPENDIX C Men’s Names
    (pp. 251-256)
  12. APPENDIX D Tables and Charts
    (pp. 257-262)
  13. Notes
    (pp. 263-332)
  14. Bibliography
    (pp. 333-364)
  15. Index
    (pp. 365-384)