Survivor of '32 Syphilis Study Recalls a Diagnosis
Survivor of '32 Syphilis Study Recalls a Diagnosis
By: James T. Wooten
Date: July 27, 1972
Source: James T. Wooten. "Survivor of '32 Syphilis Study Recalls a Diagnosis." New York Times (July 27, 1972).
About the Author: James T. Wooten was a staff writer for the New York Times, a daily newspaper with a circulation of more than one million readers worldwide.
In 1932, the U.S. Public Health Service (USPHS) under Taliaferro Clark of the Venereal Disease Division began an experiment in Macon County, Alabama, to determine the natural course of untreated, latent syphilis in African American men. The experiment, known as the Tuskegee Syphilis Study, involved 400 men with syphilis, as well as 200 uninfected men who served as controls. The men were told that they were ill with "bad blood," a rural Southern colloquialism for syphilis and anemia, but were never informed that they were participants in a study. The USPHS was investigating the possibility that anti-syphilitic treatment was unnecessary.
Syphilis is a sexually transmitted disease. In pregnant women, the disease, if untreated, is transmitted to the baby. In the primary period of syphilis infection, which lasts from three to eight weeks, a painless sore appears at the point of infection with similar sores spreading throughout the groin area, on the fingers, and on the eyelids. The secondary stage of syphilis occurs at least forty-five days after the appearance of a red, hard lesion. This stage can last for two to three years and has numerous clinical symptoms, including aching in the bones and joints, rashes, mouth sores, fevers, and headaches. Symptoms of the third stage of syphilis appear a minimum of five years after infection, but sometimes do not arise until twenty or thirty years later. In the tertiary stage, rashes appear over the entire body, hair is often lost, mushroom-like growths appear over the genitals and rectum, eye disease often occurs, and parts of the body are damaged, especially the heart, brain, and bones. The long-term effects of syphilis can include hepatitis, meningitis, central nervous systems disease, and heart and blood vessel diseases, culminating in death.
Despite the fact that major medical textbooks in 1932 advocated treating syphilis at the latent stage, the USPHS actively prevented the men enrolled in the study from receiving treatment. They were never given a clear diagnosis. In 1934, the USPHS advised local black hospitals not to treat the study subjects, and when the Alabama Health Department took a mobile venereal disease unit into Macon County in the early 1940s, the USPHS advised the health officials to deny treatment to the test subjects. At the start of World War II (1941–1945), several of the men were drafted for military service and were told by the Army to begin anti-syphilitic treatment. Concerned about the continuation of the experiment, the USPHS gave the names of 256 study members to the Alabama state draft board and asked that they not be drafted and, thus, receive treatment in the military. The draft board complied with the request. When penicillin became widely available by the early 1950s as a cure for syphilis, the men enrolled in the study did not receive treatment.
No effort was made by the USPHS to protect the wives and families of the diseased men from syphilis. The officials in charge of the experiment presumed that syphilis existed naturally in the black community, presumed that African American men were promiscuous, and presumed they would not seek or continue treatment even if given the choice.
The first published report of the Tuskegee Syphilis Study appeared in 1936, with subsequent papers issued every four to six years throughout the 1960s. Each report noted the ravages of untreated syphilis. In 1969, a committee from the Centers for Disease Control decided that the study should be continued. However, by this time, some of the test subjects had received antibiotics for other illnesses, thereby compromising the syphilis study. Only in July 1972, when the Associated Press reported the story, did the Department of Health, Education, and Welfare (HEW) halt the experiment amid great public outrage. At that time, seventy-four of the test subjects were still alive. Many of the subjects had died from untreated syphilis with estimates of the dead ranging from twenty-eight to one hundred men. In August 1972, HEW appointed an investigatory panel, which subsequently found the study to be "ethically unjustified." HEW declared that penicillin should have been provided to the men. None of the physicians who participated in the study were ever prosecuted for any crimes, although the United States did settle a lawsuit brought by the survivors and their families for $10 million.
Tuskegee, Ala., July 26— They came around one day in 1932 and told Charles Pollard he could get a free physical examination the next afternoon at a nearby one-room school.
"So I went on over and they told me I had bad blood," the 66-year-old farmer recalled today. "And that's what they've been telling me ever since. They come around from time to time and check me over and they say, "Charlie, you've got bad blood."
Yesterday, Mr. Pollard learned that, for the last 40 years, he has had syphilis. He is one of 74 survivors of a United States Public Health Service experiment in which 400 local black men went without treatment for the disease and were used without their consent or knowledge in a study of its ultimate effects.
Dr. Donald Printz of the Center for Disease Control in Atlanta said that the Tuskegee Study, as the project has come to be known, was "almost like genocide." He said that "a literal death sentence was cast on some of those people."
Today, the Department of Health, Education, and Welfare began a formal inquiry. And a spokesman for Gov. George C. Wallace said Alabama officials were attempting to determine whether state laws requiring mandatory treatment of venereal disease had been violated.
Under those laws, Mr. Pollard should have been given treatment, at public expense if necessary, as soon as the Public Health Service technicians discovered at the school that he was infected with the disease.
The Federal representative had placed him in a 200-man group of infected subjects who would not be informed of their condition or treated for it. A second group of 200 men, also infected, were to have received the best treatment available, but it was disclosed today that none of the 400 men who had syphilis was ever treated.
The third classification within the study was a 200-man group not infected.
While the study began a decade before penicillin was discovered and about 15 years before it was widely available to physicians, the Public Health Service maintained its no-treatment policy with its study subjects after the drug was determined to be effective against the disease.
The program's primary research techniques were periodic examinations and autopsies, both of which were attempts to determine what damage the untreated disease could do to the human body.
In return, the subjects were promised hospital care, free burial, and $100 for their survivors.
"But I never got into that much," Mr. Pollard said today on his 66-acre farm about three miles from Tuskegee, which is 40 miles east of Montgomery. "I've always been able to pretty much make my own way."
He was born, he said, half a mile from the little brick and frame house where he lives with his wife, Louiza. He inherited the land from his father, who was the son of a slave couple.
He appeared to be in excellent health and said he had not missed a day of working "in a long, long time." Dr. Ralph Henderson, of the Center for Disease Control, said that Mr. Pollard was probably among the one-third or so of those who contract syphilis in whom the organism either dies out or becomes dormant without medical intervention.
A newcomer to the Tuskegee Study, Dr. Henderson said that it was his understanding that the term "bad blood" was simply a synonym in the black community for syphilis.
"That could be true," Mr. Pollard said. "But I never heard no such thing. All I knew was that they just kept saying I had the bad blood—they never mention syphilis to me, not even once."
Mr. Pollard, who is described by his neighbors as a "fairly well-to-do man" was dressed today in the traditional garb of farmers in this area—faded blue overalls and a work shirt. He said he had no idea when he might have contracted the disease. He said that his only child, a daughter, was born in 1925.
"My wife hasn't had it—at least not that I know of—and I've been a clean-living man," he said in response to an inquiry about the possible infection of others.
Then he seemed weary of discussing the matter and climbed aboard his tractor. "I have to go to work now," he said. "I understand work. All of the rest of this mess I don't understand."
The Tuskegee Syphilis Study was a blatant example of racial bias in medicine. In the early twentieth century, many medical authorities (who were mostly white) wrongly considered African Americans to be especially susceptible to venereal disease due to lust, immorality, unstable families, or other social tendencies. Physicians generally discounted socioeconomic explanations for the poor state of black health and argued that better medical care could not alter the evolutionary scheme. These arguments provided the underpinnings for an ethical lapse at the USPHS, and, as a result, the USPHS jeopardized the health of an entire community by leaving this communicable disease untreated.
The Tuskegee Syphilis Study led to new standards for experiments that employ human subjects. In U.S. Senate hearings on human experimentation held in the wake of publicity about the study, physicians were reminded that the goal of human experimentation must always be to advance the human condition and to improve the situation of the subjects of the study. Institutional review boards were established to guarantee that studies are grounded in scientific principles and that the rights of study participants are protected.
In May 1997, President Bill Clinton issued a formal apology for the Tuskegee Syphilis Study on behalf of the United States government. Surviving participants and families, along with members of the Tuskegee Syphilis Study Legacy Committee, were invited to the White House to witness the president's speech.
Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press, 1981.
Reverby, Susan M. Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Chapel Hill: University of North Carolina Press, 2000.
National Public Radio (NPR). "Remembering Tuskegee." 〈http://www.npr.org/programs/morning/features/2002/jul/tuskegee/〉 (accessed October 20, 2005).