The Rationale Behind the Tuskegee Experiment

Many Americans have some knowledge of the Tuskegee Study, conducted in Macon County, Alabama, from 1932–1972. During the study, doctors and clinicians observed and tested Black men with syphilis who were unaware they had the disease and of the availability of penicillin, a known cure as early as 1938. What I’d never seen discussed was the rationale for the observation and failure to treat, in particular, the discussions about why the study should be done in the first place.

The United States Public Health Service (USPHS) initiated the initial study using 400 syphilitic Black males and 200 uninfected men as controls. The first report from the study was released in 1936, with updates released approximately every four years. If any of the diseased men sought to get treatment, they were discouraged by the USPHS. As late as 1969, the Center for Disease Control (CDC) approved the continuation of the study. Only in 1972, when the media got hold of the reports, was the study shut down by the Department of Health, Education, and Welfare (HEW). Later in 1972, HEW issued a report finding the study “ethically unjustified” and said the sick men should have been given penicillin.

The rationale for the study was centered on Darwinism. In his “scientific study” of human evolution, The Descent of Man, Charles Darwin demonstrated his belief in the superiority of Caucasians.

“At some future period, not very distant as measured by centuries, the civilised races of man will almost certainly exterminate and replace throughout the world the savage races.” — Charles Darwin

Darwinists had a lot to say about the “Negro race,” according to a review by Allan Brandt

“Essentially primitive peoples, it was argued, could not be assimilated into a complex, white civilization. Scientists speculated that in the struggle for survival, the Negro in America was doomed. Particularly prone to disease, vice, and crime, black Americans could not be helped by education or philanthropy. Social Darwinists analyzed census data to predict the virtual extinction of the Negro in the twentieth century, for they believed the Negro race in America was in the throes of a degenerative evolutionary process.

Physicians studying the effects of emancipation on health concluded almost universally that freedom had caused the mental, moral, and physical deterioration of the black population.5 They substantiated this argument by citing examples in the comparative anatomy of the black and white races” — Racism and Research: The Case of the Tuskegee Syphilis Study by ALLAN M. BRANDT

“A careful inspection reveals the body of the negro a mass of minor defects and imperfections from the crown of the head to the soles of the feet.. ..” Cranial structures, wide nasal apertures, receding chins, projecting jaws, all typed the Negro as the lowest species in the Darwinian hierarchy. — Dr W.T. English

“The negro springs from a southern race, and as such his sexual appetite is strong; all of his environment stimulate this appetite, and as a general rule his emotional type of religion certainly does not decrease it. Doctors reported a complete lack of morality on the part of blacks: Virtue in the negro race is like angels’ visits-few and far between. In a practice of sixteen years I have never examined a virgin negro over fourteen years of age. A particularly ominous feature of this overzealous sexuality, doctors argued, was the black males’ desire for white women. “A perversion from which most races are exempt, the negro’s inclination towards white women, whereas other races incline towards females of their own. Though the “gray matter of the negro brain” is at least a thousand years behind that of the white races, his genital organs were overdeveloped.” — Dr. W.T. English

The attacks on defenseless white women are evidences of racial instincts that are about as amenable to ethical culture as is the inherent odor of the race …. When education will reduce the size of the negro’s penis as well as bring about the sensitiveness of the terminal fibers which exist in the Caucasian, then will it also be able to prevent the African’s birthright to sexual madness and excess.” — Dr. William Lee Howard

These physicians believed that lust and immorality, unstable families, and reversion to barbaric tendencies made Black people especially prone to venereal diseases. Some imagined Blacks to be virtually free of disease while enslaved and that it was emancipation and lack of structure that brought on these diseases. Dr. Thomas W. Murrell said the quiet part out loud, hoping disease would rid the white man of the “Negro problem.”

“So the scourge sweeps among them. Those that are treated are only half cured, and the effort to assimilate a complex civilization driving their diseased minds until the results are criminal records. Perhaps here, in conjunction with tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.” — Dr. Thomas W. Murrell

Prior to the Tuskegee study, a 1929 grant came from the Julius Rosenwald Fund where the USPHS studied the prevalence of syphilis in the rural South and explore possibilities of mass treatment. Macon County, Alabama, had the highest syphilis rate among the six counties studied. It was felt that mass treatment could be accomplished, even in the predominantly rural County, but funding during the Great Depression was the problem.

In 1932, Dr. Taliaferro Clark, Chief of the USPHS Venereal Disease Division and author of the Rosenwald Study report, decided that conditions in Macon County merited renewed attention. Clark believed the high prevalence of syphilis offered an “unusual opportunity” for observation. From its inception, the USPHS regarded the Tuskegee Study as a classic “study in nature”* rather than an experiment. As long as syphilis was so prevalent in Macon and most of the blacks went untreated throughout life, it seemed only natural to Clark that it would be valuable to observe the consequences. He described it as a “ready-made situation.”

The Surgeon General, H. S. Cumming wrote to the Director of the Tuskegee Institute

“The recent syphilis control demonstration carried out in Macon County, with the financial assistance of the Julius Rosenwald Fund, revealed the presence of an unusually high rate in this county and, what is more remarkable, the fact that 99 per cent of this group was entirely without previous treatment. This combination, together with the expected cooperation of your hospital, offers an unparalleled opportunity for carrying on this piece of scientific research which probably cannot be duplicated anywhere else in the world.” — H. S. Cumming

Lettere between Cumming and the Director of the Tuskegee Institute, R. R. Moton, showed discussion of possible treatment but treatment never became part of the study.

“It is expected the results of this study may have a marked bearing on the treatment, or conversely the non-necessity of treatment, of cases of latent syphilis.” — Hugh. S. Cumming

All the prevailing information said treatment was preferred under any circumstances. There had been a previous Oslo Study conducted in Norway between 1891–1910 of 2,000 untreated males (penicillin was unavailable then). The community was generally protected from spread, because the patients were hospitalized and segregated from the public. The Oslo Study was viewed as a “never to be repeated study”

Dr. J. E. Moore, one of America’s leading venereologists, wrote:

“This summary of Bruusgaard’s study is by no means intended to suggest that syphilis be allowed to pass untreated.”If a complete cure could not be effected, at least the most devastating effects of the disease could be avoided. Although the standard therapies of the time, arsenical compounds and bismuth injection, involved certain dangers because of their toxicity, the alternatives were much worse. As the Oslo Study had shown, untreated syphilis could lead to cardiovascular disease, insanity, and premature death.”

Moore wrote in his 1933 textbook:

“Though it imposes a slight though measurable risk of its own, treatment markedly diminishes the risk from syphilis. In latent syphilis, as I shall show, the probability of progression, relapse, or death is reduced from a probable 25–30 percent without treatment to about 5 percent with it; and the gravity of the relapse if it occurs, is markedly diminished.”

Nowhere in the world was failing to treat syphilis advisable, not only due to possibly fatal risks to the patient but to those who would become infected because the initial patients went untreated. In spite of medical knowledge at the time, the Tuskegee study was conducted anyway because the occurrence of the disease was “natural,” and it was believed Black subjects wouldn’t seek treatment anyway. Dr. Moore who had strongly argues for treatment, served as an expert consultant to the Tuskegee Experiment, saying it was different when testing Black people:

“I think that such a study as you have contemplated would be of immense value. It will be necessary of course in the consideration of the results to evaluate the special factors introduced by a selection of the material from negro males. Syphilis in the negro is in many respects almost a different disease from syphilis in the white.” — Dr. J. E. Moore

Dr. O. C. Wenger, chief of the venereal disease clinic in Hot Springs, Arkansas, agreed with Moore’s opinion.

“This study will emphasize those differences. We must remember we are dealing with a group of people who are illiterate, have no conception of time, and whose personal history is always indefinite.” — Dr. O. C. Wenger

Early results of the study proved disappointing to the doctors conducting it. They expected to find a 35% infection rate of Black males that turned out to be 20%. They also found that a disturbing percentage of Black males sought treatment independent of the study and got cured. Damn, the bad luck.

Doctors found the recruitment of test subjects difficult. The study called for Black males between 25–60, but when limiting recruitment to those men, they got few volunteers because they feared doctors were conducting draft physicals. They ended up having to expand the group recruited to include women that would never become part of the study. The USPHS has promised Macon County they would treat any patients discovered to have syphilis not included in the study, but because the numbers were more than expected now that women were included, they treated none. Dr. Taliaferro Clark wrote about the problem:

“It never once occured to me that we would be called upon to treat a large part of the county as return for the privilege of making this study…. I am anxious to keep the expenditures for treatment down to the lowest possible point because it is the one item of expenditure in connection with the study most difficult to defend despite our knowledge of the need therefore.”

It also proved difficult to keep the subjects involved in the study without the promise of treatment. So as not to skew the results, doctors provides a drug useless in the treatment of syphilis in order to keep the men coming back for testing. The men were told they were ill and offered free treatment for “bad blood.” For the record, these weren’t rogue doctors acting on their own; this was the US Government approving these decisions to lie to Black people while watching them suffer and die without promised treatment.

“To preserve the subjects’ interest, Vonderlehr gave most of the men mercurial ointment, a noneffective drug, while some of the younger men apparently received inadequate dosages of neoarsphenamine. This required Vonderlehr to write frequently to Clark requesting supplies. He feared the experiment would fail if the men were not offered treatment.

‘It is desirable and essential if the study is to be a success to maintain the interest of each of the cases examined by me through to the time when the spinal puncture can be completed. Expenditure of several hundred dollars for drugs for these men would be well worth while if their interest and cooperation would be maintained in so doing…. It is my desire to keep the main purpose of the work from the negroes in the county and continue their interest in treatment. That is what the vast majority wants and the examination seems relatively unimportant to them in comparison. It would probably cause the entire experiment to collapse if the clinics were stopped before the work is completed.’

On another occasion, he explained: Dozens of patients have been sent away without treatment during the past two weeks and it would have been impossible to continue without the free distribution of drugs because of the unfavorable impression made on the negro.” — Racism and Research: The Case of the Tuskegee Syphilis Study by ALLAN M. BRANDT

One of the final steps of the study included a painful spinal tap to test for evidence of neuro-syphilis. Clark explained in his notes:

“We have not yet commenced the spinal punctures. This operation will be deferred to the last in order not to unduly disturb our field work by any adverse reports by the patients subjected to spinal puncture because of some disagreeable sensations following this procedure. These negroes are very ignorant and easily influenced by things that would be of minor significance in a more intelligent group.” — Dr. Taliaferro Clark

Letters were sent to the participants of the study, letting them know of this “special treatment.”

“Some time ago you were given a thorough examination and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examination. This examination is a very special one and after it is finished you will be given a special treatment if it is believed you are in a condition to stand it…. REMEMBER THIS IS YOUR LAST CHANCE FOR SPECIAL FREE TREATMENT. BE SURE TO MEET THE NURSE.”

Well into the study, the Surgeon General decided that in order to be complete, autopsies would be needed on a statistically significant number of subjects to get all the information needed.

“This study which was predominantly clinical in character points to the frequent occurrence of severe complications involving the various vital organs of the body and indicates that syphilis as a disease does a great deal of damage. Since clinical observations are not considered final in the medical world, it is our desire to continue observation on the cases selected for the recent study and if possible to bring a percentage of these cases to autopsy so that pathological confirmation may be made of the disease processes.” — Hugh S. Cumming

Doctors and clinicians were warned that the Black populace shouldn’t know about the autopsies because it would damage the study:

“There is one danger in the latter plan and that is if the colored population become aware that accepting free hospital care means a post-mortem, every darkey will leave Macon County and it will hurt Dr. Dibble’s hospital.” — Dr. O. C. Wenger

The response speaks for itself”

“Naturally, it is not my intention to let it be generally known that the main object of the present activities is the bringing of the men to necropsy. The subjects’ trust in the USPHS made the plan viable. The USPHS gave Dr. Dibble, the Director of the Tuskegee Institute Hospital, an interim appointment to the Public Health Service. As Wenger noted, one thing is certain. The only way we are going to get postmortems is to have the demise take place in Dibble’s hospital, and when these colored folks are told that Doctor Dibble is now a Government doctor too, they will have more confidence. — Dr. Raymond A. Vonderlehr

Once the story of the Tuskegee Experiment found its way into the newspapers. People involved started explaining how this wasn’t racist at all:

“I don’t see why they should be shocked or horrified. There was no racial side to this. It just happened to be in a black community. I feel this was a perfectly straightforward study, perfectly ethical, with controls. Part of our mission as physicians is to find out what happens to individuals with disease and without disease.” — Dr. J. R. Heller

“The lack of treatment was not contrived by the USPHS but was an established fact of which they proposed to take advantage.” — Dr. Charles Barnett

Starting in 1975, the federal government began providing free health care to survivors of the Tuskegee Experiment with syphilis after a class action lawsuit filed by the NAACP. In 1999, President Clinton formally apologized on behalf of the US Government. In 2017, the Justice Department, during the Trump administration, declined a request to use unallocated funds from the lawsuit to fund a Tuskegee museum honoring the victims. $10 million in reparations were allocated in 1974, but only $1 million was ever used.

Americans may have heard about the Tuskegee Experiment, possibly even later experiments on Indiana inmates or Guatemalans. I doubt many have heard about the racist beliefs justifying the research and lies. The late Paul Harvey might have said, “Now you know the rest of the story.” Unfortunately, it’s more likely the beginning.

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This post was previously published on MEDIUM.COM.

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