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

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disease 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

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of 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.

Steven Hahn, The Roots of Southern Populism: Yeomen Farmers and the Transformation of the Georgia Upcountry, 1850-1890 New York: Oxford University Press, 1983.

By Bess Beatty

Vol. 6, No. 2, 1984, pp. 14-16

When Frank Owsley completed his study, The Plain Folk of the Old South, in 1949, he considered the title “The Forgotten Man of the Old South,” but rejected it as too flamboyant. Three decades later this rejected title, enlarged to include the Forgotten Woman, would still be appropriate for a work on the white yeomen farm families who made up the majority of nineteenth-century Southerners. Southern image makers have generally continued to relegate the Southern common folk “either to obscurity or to oblivion” while they focus on the white elite, on blacks, and even on the bottom rail of white society, “the poor white trash.” As a result, Southern history remains distorted, and a large number of Southern people remain estranged from their past. Although most historians accept Owsley’s contention that “the core of the [Southern] social structure was a massive body of plain folk who were neither rich nor very poor,” they have rarely given this group in depth attention. There are hopeful signs, however, that the forgotten people of Southern history are beginning to find their historians. Steven Hahn’s The Roots of Southern Populism: Yeomen Farmers and the Transformation of the

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Georgia Upcountry, 1850-1890 joins a small but significant list of Southern studies that focus on the region’s plain folk.

Historians of Populism have given considerable attention to the issues yeomen farmers confronted and to the leaders who mobilized their protest. For the most part, however, the many good studies of Southern Populism have paid little attention to the activities and reponses of the average members of this group. When “we turn to the thousands of Southern rural folks,” Hahn explains, “the shadows rapidly steal forth.” Lifting the shadows in fraught with enormous difficulty. Yet, as Hahn notes, more written sources exist for the yeomanry than is usually acknowledged or consulted by historians. Hahn’s extensive and skillful use of a wide variety of available sources–including newspapers, letters, census returns, tax reports and various other government records–enables him to to substantiate abundantly the general story he tells. Despite Hahn’s efforts in the libraries and archives, much of the feel and sense of the yeoman culture still comes up missing in The Roots of Southern Populism. A couple of months spend living in or travelling through Georgia’s Upper Piedmont, talking with descendants of the late nineteenth century farmer folk, listening to their stories and music, looking at their family photographs and heirlooms, might have enriched and deepened Hahn’s work. Faulkner’s Flem Snopes is not enough of a substitute for the Georgia yeomanry. Neither are the written views of Floyd County planter John Dent, who appears under several guises, a large enough representation of the typical planter assessment of the times. Yet in fairness, The Roots of Southern Populism, is not intended as a study of folk culture.

Although his subjects are agrarian rather than industrial workers, Hahn’s story is strikingly similar to the recent work in American “new labor history” which has been so influenced by Edward P. Thompson’s The Making of the English Working Class. Hahn does, in fact, challenge the common view that agrarian rebellion is of a nature fundamentally different from industrial. Hahn’s Georgia yeomen, like their industrial counterparts, tried to retain autonomy and to resist the encroachments of capitalism–in their case commercial agriculture–by clinging to precapitalistic norms and prerogatives.

Establishing the cultural and economic roots of Populism over a forty year period forces Hahn to confront one of the most perplexing questions of Southern historiography: If, according to conventional wisdom, “Southern yeomen were touchy and isolated individualists,” how could they have been lured by the Populist vision of a cooperative common” wealth? In his penetrating analysis of the multi-faceted nature of yeomen independence, Hahn offers a significant new perspective on the question. Although he agrees with the traditional contention that yeomen economic organization based on the household and fee-simple landownership “fostered the bourgeois traits of individualism, acquisitiveness and deep adherence to private property”–traits that meshed well with the emerging ethic of laissez-faire economics–he also argues that “strong countervailing tendencies” existed. In direct contrast to the laissez-faire ethic, a “preindustrial republicanism” convinced many of the Upcountry ;yeomen that the state should control productive resources and actively defend petty producers. Further more, Hahn contends, yeomen independence also “hinged on social ties, on ‘habits of mutuality’ among producers, that impart to their culture a communal, prebourgeois quality whose equalitarian proclivities sharply distinguished it from that of the planters.” As a result of his careful analysis of the meaning and limits of independence in the economic and social lives of the Georgia yeomen, Hahn concludes that Populism was not an aberration in Southern Upcountry life but a product of a deeply embedded world view.

Before the war, class conflict resulting from distinctive planter and yeomen world views was latent, muted by planter efforts to unite their region in the growing struggle with the rest of the country. The yeomen enjoyed a large measure of autonomy; popular laws and customs, such as the homestead exemption and access to common lands, were protected. But the social fabric which sustained yeomen autonomy began to unravel under the strains of war. War-time privations combined with Confederate taxation and impressment policy made the yeomen increasingly resentful and generated “growing class antagonisms,” which were further exacerbated by severe economic dislocations in the wake of Confederate defeat. Hahn rightly argues that transformations in the lives of the Upcountry yeomen “during this period elucidate the larger meaning of the Civil War itself.”

Central to the economic change which these people confronted was the transformation of the Georgia Up-

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country from an area of subsistence agriculture on the periphery of the cotton economy to the mainstream of commercial agriculture. In a period of such widespread destruction and rapid change, these farmers could no longer opt for the “safety of diversification.” They rapidly lost their self-sufficiency as they were forced to plant cotton, the only crop on which they could receive credit. As a result, the Upcountry, previously “the domain of yeomen freeholders,” fast became ” a territory of the disposed.” Merchants, protected by lien laws, replaced the communal prebourgeois network of exchange characteristic of antebellum Upcountry society. “By the 1880s,” Hahn finds, “an elite deriving surpluses from both land and commerce held the economic reins in the upcountry.” Increasingly the “republicanism of petty producers” was arrayed against “the values of the free market.”

The inevitable postbellum class conflict took on a uniquely Southern tone because of simultaneous racial conflict. Hahn offer important, but sometimes contradictory, analysis of the old question concerning how much coming together there actually was between the South’s poor black and poor white farmers. Georgia Republicans, he asserts, had a chance after the war to build a biracial coalition, but they failed to do so. However, Hahn presents so much evidence of deep-seated yeomen racism that he undermines his own argument. He is more persuasive in claiming that the Southern yeomen viewed blacks, both in slavery and freedom, “as symbols of a condition they most feared–abject and perpetual dependence–and as a group whose strict subordination provided essential safeguards for their way of life.”

But racism was not sufficient to keep the yeomen loyal to elitist Democracy. By the 1870s election returns revealed “emerging divisions between town and countryside and between rich and poor farmers.” The issue that most polarized Upcountry white society was the question of grazing rights which, Hahn claims, “revealed the cultural, as well as economic, dimensions of political struggles, and . . . paved the road to Populism.” Since colonial days both law and custom had required that crops be fenced so that farmers could allow their animals to graze on open lands. To small landholding farmers as well as to tenants, the right was an essential prerequisite for self-sufficiency. In the post-war world, when a new elite pushed for laws requiring the fencing of stock, the yeomen, still informed by a preindustrial ideology of republicanism, fought, not only for “local custom,” but also for what they perceived as their “natural right.” It was the struggle over grazing rights, Hahn contends, that first aroused the upcountry yeomen; “the appearance of the Southern Farmers Alliance and then the People’s party promised to transform defensiveness into a humane and progressive force.”

Hahn successfully challenges most historians of Southern Populism with his compelling argument that the appeal of Populism to Upcountry Georgia yeomen farmers was more than a factor of their increasing impoverishment; the movement also offered a vehicle to restore “a producers commonwealth” which had been overwhelmed by the encroachments of the free market. To the yeomen who joined the Populist revolt, the party’s goals were “a vision informed by historical experience.”

For myriad reasons Populism quickly failed. One important reason, according to Hahn, was the two-sided nature of the yeomen sense of mutuality which made this cooperation possible. He argues that the “very networks and norms of the household economy partially disguised class distinctions and probably discouraged reliance or. supralocal, unfamiliar, and more formalized organizational’ structures.” This meant that, art least in the Georgia Upcountry, Populism rested on “a tenuous foundation.” But to Hahn, as to Lawrence Goodwyn, author of Democratic Promise, the most important book on American Populism, the rapid failure of Populism should not be construed to minimize its historical importance and ideological legacy. What Goodwyn describes as “the largest democratic mass movement in American history” is to Hahn “a watershed in the history of industrializing America.”

Steven Hahn’s book is excellent history, but it is more than that; it is also an excellent study of the interaction of the powerful and the powerless. The descendants of these Upcountry yeomen know little of their ancestral legacy of cooperative republican and rebellion. Goodwyn has written that “more often than not, the triumph of the received culture is so subtle it is not apparent to its victims. Content with what they can see, they have lost the capacity to imagine what they can no longer see. Ideas about freedom get obscured in this way.” The importance of Hahn’s book is as current as it is historical.

Bess Beatty is assistant professor of history at Shorter College in Rome, Georgia.