Bad Blood: The Tuskegee Syphilis Experiment. By James H. Jones. New York: The Free Press, 1981. $14.95.By Bess Beatty
Vol. 4, No. 6, 1982, pp. 17-19
In 1972 the Associated Press broke the story of the Tuskegee experiment, a forty-year study of the effect of syphilis on six hundred Macon County, Alabama, black men. Nine years later James Jones published Bad Blood, a history of what he describes as "The scandalous story of the Tuskegee experiment--when government doctors played God and science went mad." Jones' book is a thoroughly researched and dispassionate, although indicting, account of this experiment.
The story has a background imbeded in centuries of "racial medicine." By the twentieth century syphilis had come to be considered by many physicians as "the quintessential black disease," and, despite the insights of modern medicine, some continued to believe that it affected blacks differently than whites. Ironically the Tuskegee study grew out of changing attitudes, at least among public health officials, toward black health generally and syphilis particularly. By the 1920s contempt and neglect were beginning to give way to realization that scientific and medical insights should be applied equally to all races.
In 1929 the Julius Rosenwald Fund, renowned for its efforts on behalf of black education, began funding Public Health Service programs for blacks. The pilot program, planned to demonstrate control of veneral
Page 18disease in five Southern rural counties, included Macon County, Alabama, which was eighty-two percent black and which had, despite the presence of famed Tuskegee Institute, the highest syphilis rate uncovered by the study. Although of short duration, the Rosenwald program eventually inspired a nationwide campaign to test and treat syphilis--an effort that excluded six hundred Macon County men who were involved in the original study.
The Tuskegee experiment, in which they were now involved, grew out of frustration at the termination of Rosenwald funding. Director Taliaferro Clark, who "would have preferred to . . . treat rather than to study syphilitic blacks," settled for a less expensive project, The Tuskegee Study of Untreated Syphilis in the Negro Male, which was to become "the longest nontherapeutic experiment on human beings in medical history." Dr. Clark planned to study empirically the long held notion that syphilis affected blacks differently than whites by comparing his findings to a study of untreated syphilis in white males in Oslo, Norway. Clark expressed no ethical qualms as he prepared for the "unparalleled opportunity," but neither did he envision that the men would go untreated longer than the six months he expected the experiment to last. To assure local black support, the Tuskegee Institute was made partner of the Public Health Service and its name was applied to the study. Dr. Raymond Vonderlehr was selected to be in charge of field work and Eunice Rivers, a black nurse, was appointed to assist him. Initially some minimal treatment was included which would eventually evoke the scientific criticism that the experiment was invalid as a study of untreated syphilis.
But it was the ethical dimension that would eventually condemn the Tuskegee study as the most infamous episode in the history of government medicine in the United States. The program was couched in deceit from the beginning. Patients were told that they had "bad blood," not that they suffered from a particular disease that was contagious and transmitted sexually. Those brought in for painful and dangerous lumbar punctures which were strictly diagnostic were told that they were receiving "special treatment."
When Dr. Vonderlehr, who was making a career out of the Tuskegee work, was named to replace Clark, the decision was made to continue the study indefinitely. His plan entailed low-cost examination of each man, facilitated by Nurse River's personal contact, until each could be "brought to autopsy." Their efforts to keep the men involved in the study were facilitated by continued deceit, non-effective medication such as asprin, burial stipends, and occasional certificates and cash awards. The support- of the Tuskegee Institute and area physicians, both eager to participate in a national scientific study, assured the experiment's survival. Although poor blacks in Macon County could rarely afford to see a doctor, the cooperation of area physicians was still profoundly significant because men who were "potential patients" were made "perpetual subjects . . . placed beneath a microscope for scientific observation." How callous the Public Health Service became toward these subjects is indicated by a letter from Dr. John Heller, field director of the study, complaining of the availability of Civil Works Administration jobs for blacks because it "disrupted the Ethiopian population as regards staying in one place very long." Heller later recalled, "No one questioned whether the experiment was ethical; no one even came close to doing so."
Initially, denial of treatment was rationalized (by those who bothered to rationalize at all) on the grounds that the treatment available for syphilis could be as hazardous as the disease. This justification was rendered more difficult in the 1940s when the discovery of penicilin offered a safe, effective syphilis treatment, but by then the study had acquired a bureacratic momentum, a self-perpetuation, that made it immune from challenge. Leadership continued to come from within, and no one involved considered ending the work.
It was not until 1966 that Peter Buxton, a venereal disease interviewer in San Francisco, learned about the study and protested. Officials, still convinced of the experiment's scientific merit and moral intergrity, rejected Buxton's criticism and vowed to continue. Finally in 1972 they were overruled when the Associated Press, proded by Buxton, told the story. A nine-member and it was disbanded. Out of court settlement awarded the surviving syphilitics $37,500, with lesser amounts to their heirs and to those in the control group.
Beyond the specific appalling story it tells, Jones' book is important for offering insight into power relationships in American society. Despite the repeated denials of the officials involved, the experiment serves as an example of the power of racism and elitism and as an indictment of the limits to the paternalism and liberalism which have allegedly served to temper these prejudices. Jones describes the health officials who originated the study as paternalistic compared to "the real black-baiters of the day." They were of the progressive or liberal wing in American society which counseled government sponsored improvement of the environment for blacks and the poor. But the book reveals the stark limits to a liberalism and paternalism which views the dispossessed as more subject than human.
Bad Blood also demonstrates the dangerous potential
Page 19of a science without ethics. The Tuskegee experiment had almost complete support from scientists within the Public Health Service, and was not challenged from within even after the Nuremberg trials sensitized the world to the potential of science gone mad. When the study was uncovered in 1972, the scientific community was most vocal in its defense.
This example of "moral astigmatism" within the medical and science professions make a strong case for closer government supervision of medical activity, but the question remains--who will supervise the government? Most appalling to many people was the revelation that a federal agency had conducted the experiment. It was, the Providence Sunday Journal charged, "flagrant immorality . . . under the auspices of the United States Government."
Jones also questions why none of the hundreds of individuals involved protested. Sidney Milgram, in his study Obedience to Authority, claims that "Pure moral autonomy in the form of lone resistance to an apparently benign authority is very rare." His conclusion is upheld by the example of scores of people who could have protested medical experimentation but did not. Jones makes the frightening comparison of the Public Health bureaucracy to the military hierarchy of Nazi Germany which "reduced the sense of personal responsibility and ethical concern." He is particularly interested in why so many blacks cooperated with the Tuskegee work and conjectures that black professionals were responding to "the dilemma of black middle-class professionals who wanted to succeed in a society dominated by whites." This was clearly true of Nurse Rivers, the most poignant figure in the book and the one official involved who had genuine concern for the welfare of the men involved. She was bound by forces of race and class as well as a professional hierarchy that demanded obedience to doctors and sex roles that "reinforced her ethical passivity."
Jones' book can be criticized for leaving the men involved as lifeless as they were considered by the experimenters. Nevertheless, he has told their story well: "a forty-year saga of lies and deceit, of unlettered men who had trusted and been betrayed by educated men." As the major indictment of "the scandalous story of the Tuskegee experiment," this important book deserves to be widely read.
Bess Beatty is an assistant professor of history at Shorter College, Rome, Georgia.