More Than Fact and Fiction: Cultural Memory

More Than Fact and Fiction: Cultural Memory and the Tuskegee Syphilis Study
Author(s): Susan M. Reverby
Source: The Hastings Center Report, Vol. 31, No. 5 (Sep. - Oct., 2001), pp. 22-28
Published by: The Hastings Center
Stable URL: http://www.jstor.org/stable/3527701
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than
More
Cultural
and
Fact
and
Fiction
Memory
the
Tuskegee
Syphilis
Study
NobodyAroundHere CallsMe Citizen,by RobertGwathmey,1943.
of
Frederick
R.WismanArtMuseum,
of Minnesota,
Collection
University
Minneapolis.
Bequest
fromtheloneandHudson
Hudson
Walker
WlkerCollection.
by SUSAN M. REVERBY
The TuskegeeSyphilisStudyis surroundedby illuminating
misconceptions-myths that cannot be
blithelydismissedbecause they actuallyprovidesome insightinto the significanceof the study.One of those
is thatthe men were deliberatelyinfectedwith syphilis;another is thatthey obtainedno treatmentfor the
disease. Some other errors are alleged in two recent articlesabout the study,but these articlesthemselves
create their own fictions.
espiteits long historyas a crucialsite in the and 201 controls, led to a lawsuit, Senate hearings,a
fight for racialjusticein America,Tuskegee, federalinvestigation,and new rulesabout informed
Alabama,will be foreverlinkedin America's consent.It provideda powerfulmetaphorfor racism,
collectivememoryto theTuskegeeSyphilisStudy.'In ethicalmistakes,and the dangerof state-runmedical
thissmallsoutherncommu- research.It has also generatedrumors, historical
the countiessurrounding
nity,the U.S. PublicHealthServiceran a forty-year monographs,videos, documentaries,plays, poems,
a surgeongeneral's
study,from1932 until 1972, of"untreated
syphilisin music,a movie,photo-montages,
nomination
a
apology,a comhearings, presidential
the maleNegro,"while tellingthe men in the study
new
anda Namon
for
IRB
that theywerebeing"treated"
for their"badblood."
topic
training, memorials,
tional
Bioethics
Institute.2
The outcryover the study,which affectedapproxiThe Tuskegeestudyis thereforean experiencefor
men with the disease
mately399 African-American
historical
which thereis no longera straightforward
a
and
moreover
it
cannot
offer
narrative,
simplemoralSusanM.
"Morethan Factand Fiction:Cultural
and
D
Memory
Reverby,
the TuskegeeSyphilisStudy,'HastingsCenterReport31, no. 5 (2001):
22-28.
22
HASTINGS CENTER REPORT
ity tale. Rather,it existsin the liminal areaof historical
asa set of experiences
to be used
fog andfact,available
September-October 2001
by those who wish to tell differing
tales, make various political points,
and remember in discordantways.3
As with other stories of critical importancein our nationalheritage,and
especiallythose that focus on raceand
sexuality, the study endures on the
cusp of memory and fact and in
imagination,nightmare,and historical accountingat the same moment.
Understandingthe studys current
import requiresan assayingof these
beliefs and memories,exploringhow
and wherethey travel,the experiences
they build upon, and the truths they
proclaim.4Fact and fiction have long
circulated about the study, and the
misreadingshave at times servedimportant cultural functions. More recently, two new articlesappearingin
medical-relatedjournalsquestion the
current historical orthodoxy on the
study by focusing primarilyon the
medical facts of treatmentprotocols
for late latent syphillis. I will argue,
however,that a differentkind of fiction is created when the "facts"of
medical uncertainty,even when historicized, are separated from a nuanced analysisof the interactionsbetween raceand medicine.
The "Fact" of Deliberate
Infection
he sourceof the men'ssyphilisis
often a disputed"fact."The high
rate of infection in the counties near
Tuskegeemade the areaof interestto
the PHS,5 and the PHS located the
men who became the study'sunwitting subjectsafterthey tested positive
for the disease (using the Wassermann test), gave a clinicalhistoryof
the infection, and were diagnosedas
being in the disease'slatency stages.6
This is made clear in all the major
historicalworkson the study.7
The belief persists,however, that
the PHS actually gave the men
syphilis.This story has appearedon
an NBC evening broadcast,an Eddie
Murphy cartoon series, a scholarly
scientific paper, talk radio call-in
shows, and in community rumors.
effect. It is even sometimes believed
that the World War II Tuskegeeairmen were the ones targeted,perhaps
because the first military training of
African American pilots was frequently referredto as "the Tuskegee
experiment."Or perhapsthe fact that
LaurenceFishbournestarredin separate HBO movies, first about the airmen and then about the study,causes
confusion.
To understandTuskegee'ssymbolic power it is necessaryto understand
why this fiction persistsand what it
teachesabout the makingof historical
meanings. "The wrong tales,"Italian
oral historian Alessandro Portelli
writes, "allowus to recognizethe interests of the tellers and the dreams
and desiresbeneaththem... [E]rrors,
inventions, and myths lead us
through and beyond facts to their
meanings."8If the story that the men
were given syphilisis an "invention,"
then what are the "dreamsand de-
The-belief that the men were given a disease that
-
fit racist assumptions
September-October2001
about black male sexuality
slips without question into the folklore of horrific
modes of control over black bodies.
sires,"as Portelli would have it, beneath them?
This wrong tale is of course more
nightmarethan dream.Health educators have called the belief that the
men were intentionally infected a
"disastermyth" for some in African
Americancommunities.It is a way to
explain the "pervasivesense of black
mistrust of public health authorities" a mistrustthat historianshave
noted goes back furtherin the experiences of black America than the
TuskegeeStudy.9Slaveholdersintentionally induced fears of "night riders"who would whisk black people
away for experimentation. Dr. J.
MarionSims, the "fatherof American
hasbeencorrectedmany
The "error"
gynecology," used black women
to limited
timesover,but apparently
slavesto perfecthis proceduresto repair vaginal fistulas. Grave robbers
sold black remains as cadavers to
medical schools, creating what has
been labeled a form of "postmortem
racismin 19th centurymedicaltraining."10This list goes on and on and
into recent memory: rumors persist,
for example, that HIV/AIDS is a
medical experiment gone awry or a
straightforwardeffort simply to reduce the numberof Africans.
The belief that the men were deliberatelyinfected thus fits both folk
and historicalknowledgeof the use of
black bodies. It accords with what
folkloristPatriciaTurnerdescribesas
pervasive"metaphorslinking the fate
of the black raceto the fates of black
bodies, metaphors in use since the
very first contact betweenwhites and
blacks."1lIf difference is ultimately
presumedto be in the body, then the
taking or poisoning of blood, in this
case literally making it "bad," be-
comes an ultimateform of control to
define the natureof that difference.12
In this case, the belief that the men
were given a diseasethat fits racistassumptionsabout blackmale sexuality
slips without question into the folklore of horrificmodes of control over
blackbodies. It is a story used to cope
with some of the racismand the continual dangerto bodily integritythat
overshadowthe experiencesof many
AfricanAmericans.It is a "fact"that,
while not true, is certainlyplausible,
and it links historicalexperienceto a
pervasiveessentializingthat continues
to characterizeracializedbeliefs.
Plausibilityand essentializingare
not the only explanations for why
NBC got its facts wrong, however,
HASTINGS CENTER REPORT 23
nor for why many others who could
easilyreadthe historicalaccountsperseverein believingthat the men were
given syphilis. Sloppy reporting,lazy
research,and a willingnessto believe
what floats through a rumor-soaked
culture could explain any of this.
Also, in a strangeway the horrificnotion of deliberateinfection makes it
easierto deal with the study.To suppose that the subjectswere deliberately infected makes the study unquestionably abnormal,a failureof ethics
on a grandscale.It makesthe doctors
who conducted the study American
equivalents of the Nazi experimenters. The common assumption
that the Nazis were an aberrationattaches to Tuskegee,and the men in
Alabamabecome victims of a different kind of Holocaust.Thus this parallel imagined leap fixes both the
physiciansand the men in Tuskegee
The study,like the horas "others."13
rorsof the Nazi era, becomes a problem of a specific group, time, and
place.14
If we understand that the men
werenot deliberatelyinfectedbut also
were not told they were in an experiment, then we integrate the study
into the racializedlogic of American
medical science at the time and the
use it made of black bodies.Then indeed the racism, and its role in the
evolution of medical science, becomes a much more typical experience. This way of making decisions
about care-giving it to some, denying it to others-is also an increasingly familiar experience today, even a
necessity,some would argue.It is easier for us to deny the study'sreality
and make the PHS doctorsinto Nazis
and the men absolute victims. The
deliberateinfectingof the men is thus
a fiction that passesfor fact becauseof
what it reflectsideologicallyand historically.
Hidden Treatments
n a similarmanner,even the seemingly obvious "fact"about "nontreatment"in the study bears scrutiny. The central reality of the study,
24
HASTINGS CENTER REPORT
documented in the PHS-Tuskegee
correspondence, is that the researcherstried to deny the men treatment for their disease.This was designed as a study of "untreated
syphilis in the male Negro.""5The
PHS did many things to keep the
men from treatment:tracking them
to other public health departments
across the country, interveningwith
local physicians and even the local
draftboard,perpetuatingthe falsification that they were being treatedby
providingaspirinsand vitamins, and
lying.16
Intentions, however, even when
backed by the power of the state, do
not alwaysbear out as expected. No
research study, especially one that
goes on this long, is everexactlywhat
it proclaims. And the men in the
Tuskegeestudywere capableof someSome
times thwartingthe researchers.
the
rerefused
to
let
of them just
searchers do everything asked of
them, as the correspondencebetween
the researchersmakes clear.They did
not show up when the nursescame to
get them, they refusedto have their
blood drawn, they reported themselvesas well and would not come in.
Not all familiesagreedto autopsies.17
Nor did all the men stay in or
aroundTuskegee,contraryto the researchers'belief that they were firmly
rooted in the BlackBelt soil of Alabama. Some of them joined the great
mid-century migrations out of the
South and into the North and Midwest, and the researchers'efforts to
find them as they moved and to keep
them from treatmentwere not always
successful. With the expansion of
publicly availablecare in urban settings and perhaps with help from
families and friends, some of those
who made it out of Tuskegee also
made it to some form of treatment,as
documented on the patient records.
Of the seventy-one survivorswhose
patient records became available in
the mid-1970s, for example, 21 percent of them wereno longerin Alabama, and a number of these men had
receivedtreatmentelsewhere.
Physicalescapefrom Alabamawas
not the only way to find treatment:
physiciansin Tuskegeewere treating
some of the men as well. Dr. Robert
Story, a local Tuskegeephysician, recalled hospitalizing a patient who
needed penicillin for his nonsyphilitic illness. Story was told by a
nurse (not connected to the study) to
withhold penicillin and to call the
local health departmentbecause the
man was a "government patient."
Story tried the phone call, but it was
after 5 p.m., and no one answered.
The man receiveda full seriesof penicillin shots.18
Such "accidental"treatmentis almost inevitable.Even more interesting is that severalof the men also received penicillin from two Tuskegeebased doctors who were involved
with the study-from Dr. Murray
Smith at the Macon County Health
Department and from Dr. Eugene
Dibble at the Tuskegee Institute's
John A. AndrewHospital.In fact, the
patient records show that nearly a
third of the men who eventuallyreceived some penicillin got it from either Smith or Dibble. The records
note the men's syphilis, then document that they receivedpenicillin for
colds, flu, or back pain. Other men
obtained referralsout of the Macon
County Health Department to the
syphilis rapid-treatment clinics in
Birmingham (although in the early
yearsof penicillintreatment,from the
mid 1940s until the mid 1950s, it
was common not to treat late latent
syphilisin older patients,and at least
one survivorlaterclaimedthat he was
turnedawayfrom a clinic in Birmingham becausehe was in the study).19
The records and interviewingdo
not make it clearwhy all of this happened. There is no way to know if
Dibble or Smith treated some subjects deliberatelyor accidentally,or
indeed if the patient recordsareaccurate. Many of the men had not been
seen for yearsby the PHS researchers,
even if they were visited regularlyby
the nurses.When they showed up at
the health departmentor at the clinics at Tuskegee's John A. Andrew
September-October 200 1
Hospital with assortedills, they may
simply not have been recognized.Alternatively,Smith and Dibble might
have given them penicillin intentionally,as a way to easetheirconsciences.
Under the circumstances,this way of
thwarting the study could easily be
kept hidden.20
Ultimately,the Tuskegeestudywas
of undertreated
ratherthan of purely
untreatedsyphilis.Between 1932 and
1936, some men in the subjectArm
of the study had some of the then
known treatments of neo-arsephenamine and bismuth, even if
never the amounts recommendedfor
"cure"(as was common throughout
the country at the time). Of the seventy-one survivors with patient
records,nearlythirty reportedreceiving some kind of heavy metals treatment in the 1930s and early 1940s.21
Some of the men who survivedinto
the antibioticerawere able in various
ways, often unknowingly,to slip out
of the controlof the PHS and receive
penicillin, sometimes for their
syphilis,at other times for other ills.22
Of the seventy-one survivors with
records, thirty-five (sometimes the
same men who had obtainedthe earlier treatment) received some penicillin from the late 1940s up until
the early 1970s, when the study was
closed down.
There is no way to tell precisely
how many men had some treatment,
nor what the effect of the treatment
was, since the seventy-one survivors
in 1972 are only 18 percent of the
men with syphiliswho were included
in the study and there is no reliable
informationon what happenedto the
other 328. But as the authorsof the
thirty-yearreporton the study somewhat reluctantlynoted in 1961, "approximately96% of those examined
had receivedsome therapyother than
an incidentalantibioticinjection and
perhapsas many as 33% had curative
therapy."23(The PHS's estimates of
how many men may have received
some treatmentchanged from report
to report, suggesting either sloppy
statisticalwork and epidemiological
explanationsat the PHS or outright
September-October200 1
fudging of the data.) Similarly,the
PHS'srecordssuggestthey were never
able to get as "clean"a subjectpool as
they hoped and that undertreatment
was the norm.
The facts about treatmentare significant for our understandingof the
study in severalways. First,the "fact"
of nontreatment accurately reflects
the PHS'sintent, even if it was not always true of the men'sactual experience. It illustratesthe power of supposedly powerlessindividualsin dayto-day life to undermine, by resolution or by chance, even powerful
schemes.Just as with the historiography on slavery,it is criticalto remember that in everydaylife, controlscan
be shatteredin inventiveor arbitrary
ways.
Second, the realizationthat there
was some treatmentallowsus to speculate about how much collaboration
effect also of distancing the reader
from the human beings involved.25
These articles, and other commentaries on the study as well, suggest
that the men belonged to one large
group; it is almost as if the words
"399-Alabama-black-rural-sharecropping-illiterate-men"are instead one
word.The differingoccupational,educational, and personal identities of
the men areerasedas they become, as
a group, every Southern black man,
availableas symbols of victimization.
This way of imagining or reporting
on the men is a form of re-victimization.
Tuskegee's symbolic importance
makes it culturallydifficult, however,
to considerthe seeming "facts"of the
study alone. Especiallyafterthe 1997
presidentialapology, media and cultural attention have refocused on
Tuskegee and its racial assumptions
The- fact" of nontreatment
accurately
reflects
PHS's intent, even if it was not always
the
true
of the men's actual experience.
actually occurred on the local level
with both the Tuskegee Institute
(now University) and the local
Macon County Health Department.
Clearly they were cooperativeat the
beginning of the study in the 1930s,
and autopsies continued throughout
the studyat the JohnA. AndrewHospital. But the evidence on treatment
suggests that by accident or design,
not everyoneon the researchside of
the study operated as efficient state
machinery.
Third, the evidence that some
men receivedtreatmentis a reminder
that they were not one group of undifferentiatedvictims.24It is common
in medicalarticlesto coverup the humanity and individualityof the subjects (indeed, their facesoften remain
hidden in photographs),ostensiblyto
protect their "privacy"but with the
and made the facts still more elusive.
Concern over rising AIDS rates, the
African American communitys lack
of participation in clinical studies,
and revelationsof abuse of research
and informed consent protocols in
the nation's leading medical schools
and hospitals have also added to
Tuskegee'sascendingmetaphoricstatus.
Recent Revisionism
n the face of this contemporary
resurgenceof interest in Tuskegee
and the emphasison its racialcomponent, two recentarticlesbearscrutiny.
Both are written or co-authored by
historian-physicians-Thomas
Benedek,JonathanErlen,and Robert
White-and both focus on the "medical facts"of the study, and especially
HASTINGS CENTER REPORT 25
on the medical uncertaintiesin the
firsthalf of the twentiethcenturyconcerning the necessityof heavy metals
therapiesand penicillin for late latent
syphilis.26
They underlinethe dangers
these therapieswere believed to pose
to patients.In the so-called"therapeutic paradox" of the Jarisch-Herxheimer reaction, for example, killing
the disease-causing spirochetes can
have the side effect of causing fevers,
dangerous cardiovascular damage,
and life-threateningharmto an oftenasymptomatic patient. The articles
provideevidencefrom the medicalliteraturethat until the 1960s, nontreatment for late latent syphilis was a
more common practice than earlier
historicalaccountshad allowed.27
Accordingto Benedek, Erlen, and
White, an understandingof the medical practice surrounding syphilis
treatmenthelps to explainwhy there
was almost no outcry over "nontreatment" in the Tuskegee study even
afterthirteenreportsof the study had
been published in reputablemedical
journals.28This understanding likewise sheds light on the anger and silence with which olderphysiciansand
syphilologists, who remember the
medicalcontroversiesand practicesof
the period, often greet discussion of
the study.29The articlesare criticalof
the work of other historians of the
study, and especiallythose concerned
with race. The existing work, they
claim, suffersfrom eitherbias or "presentism"-that is, a failureto evaluate
the study in its appropriatehistorical
context.
Historicalaccounts are, of course,
open to criticism and may fail to
cover all aspectsof an event as complicatedas Tuskegee.But by claiming
to have reachedthe "truth"about the
medical context, these two new articles also hide some fictions. This becomes clear when the arguments
about racism are examined more
closely. Robert White, for example,
uses the work of African American
physician William Hinton, a wellknown and respectedsyphilologistin
the 1930s, to show that nontreatment
for older latent caseswas an accepted
26
HASTINGS CENTER REPORT
practice.30White also cites a study at all the medical hazards, "it would
Stanford in the late 1940s on both seem not unreasonableto treatall pawhite and black syphilitic patients tients with late latent syphiliswho are
with late latent disease.At the Stan- in good health if they have not passed
ford clinic, the policy was "to permit the age of 60." This was, one of the
patientsof more than 50 yearsof age Stanfordauthorsargued,a reversalof
to remainuntreatedprovidedthat the his earlierposition on non-treatment.
infection was entirelylatent and that The Stanfordphysicians also treated
the spinal fluid was normal."31
White patients of neurological disease and
uses this study to arguethat the Stan- those they classified as "uncooperaford physicians "willfullyand inten- tive." Further, they concluded,
tionally denied treatmentto patients "[s]houldpenicillinproveeffective,all
of both races"even while "atreatment argumentsagainst the routine treatprogram was in place."32Using the ment of latent syphilis should van"facts"of this study and others,White ish."35This was in markedcontrastto
wants to informthe AfricanAmerican Tuskegee,of course,where uncertaincommunity that the abuse they fear ty over treatmentor discoveryof furfrom studies directedat them may be ther illness neverled at least the PHS
physiciansto offer treatment.
misplaced.
In any event, the Stanford study
There is a very complicated line
betweenunderstandingor contextual- does not put to restall concernsabout
izing and providing"moralshelter."33 the racial assumptionsthat underlay
Indeed, a recent Holocaust scholar the Tuskegeestudy; nor does the fact
has suggestedthat "understanding.. . that the Stanfordstudy also had white
threatens to cripple judgment, be- patients deny the racialization at
causeto understandis almost to justi- Tuskegee.White and Benedek/Erlen
fy," even when is not an author'sin- would have profited from exploring,
tention.34 Both the White and the for example,the ideasfirstintroduced
Benedek/Erlenarticlesstirreddiscus- in the well-known and well-docusion in the public health and history mented 1942 book by Universityof
of medicine communities precisely Chicago and Provident Hospital
becausethe issue of treatmentgoes to pathologistJulianHermanLewis, The
the heart of Tuskegee's meaning. Biologyof the Negro.3 Lewis argued
These articles.... providemore med- that the studies of the prevalenceof
ical context for the study than has syphilisin black people often conflatpreviously been widely known, but ed racewith class and that the prevatheir exposition of the context is also lence was due more to lack of educaincompletein significantways.There tion and treatment. Lewis also
was a medical debate over how to claimedthat higherratesof syphilisin
treatolderpatientswith latentdisease, black people could be explained by
and practices surely varied, but the fact that as a people they had hisnowhereelse (at least from the extant toricallyhad less exposureand thereevidence we have) were patients de- fore less resistance to the disease.
nied treatmentand lied to for so long. Lewisnoted that the Wassermanntest
That the study continued well into often gave false positivesand that the
the civil rightsera is astounding.Fur- possiblelink betweenserologicalposither,the fact that it was conductedby tives and malarial histories needed
an arm of the United States govern- further study. He did not consider
ment makesit differentfrom research whethertreatmentshould be different
for blacks than for whites, but he at
conductedin other medicalcenters.
Nor is the exposition even of the least suggestedthat at the time of the
medical context quite complete. The study therewere other ways of under1948 Stanfordreportthat White cites standing the racialization of
does not make clearwhat kind of in- syphilis. 37
In sum, these recenthistoricalartiformation was given to the patients,
create their own fictions about
cles
that
but the authors conclude
given
September-October 2001
the relationshipof medical science in
this country. It too must be historicized; its facts and meanings must
contribute to our understandings.38
These authorshave not examinedthe
racism of linking syphilis to black
people as an "intrinsicdefect."They
havenot consideredthat given the experience of blacks in the United
States,a study like Tuskegeeis significant even if white subjectswere treated badly elsewhere.By ignoring this
contextand the meaningsof the black
experiencewith medicine, these authors fail to link raceand medicaldecisionmaking.39Understanding why
nontreatmentwas common is important, but it does not explainTuskegee
awayor even addresssubstantiallythe
fears of the black community about
medical treatmentand experimentation.
In casesof both individualand collective trauma,what is visible is often
less criticalthan what we cannot see.40
The collectivememoriesof eventstell
us much about historical moments
and must be analyzedalong with the
"facts"that get emphasizedor chosen.
Re-analyzingthe past and searching
for new meaningsand new facts will
be a continualprocess,as the different
groups make differing claims about
the study.HistorianDavid Blight has
arguedthat in our thinking about the
Civil War,"healingand justicehad to
happen in history and throughpolitics.
... And as long as we have a politics
of racein America,we will havea politics of Civil War memory."41
For the
AfricanAmerican,public health, scientific research,and bioethics communities, there will alwaysbe a politics of Tuskegee memory as well.
Analysis of this history and politics
must be part of our practice if the
study'sevolvingmeaning is to be understood.
Acknowledgements
I am grateful to William W Quivers,
James H. Jones, Evelynn M. Hammonds, and the anonymous reviewers
of this paperfor theirthoughtfulquestions and assistance.Commentsfrom
September-October200 1
audiencesat the Southern Historical
8. A. Portelli,TheDeathof LuigiTrastulli
and OtherStories(New York:SUNY Press,
1991), p. 2.
9. S.B. Thomas and S. Crouse Quinn,
"The Tuskegee Syphilis Study, 1932 to
1972: Implicationsfor HIV Educationand
AIDS Risk Education Programsin the
Black Community,"AmericanJournal of
PublicHealth81 (1991): 1498-506. HistorianV.N. GamblearguesthatThomasand
Texas,Galveston,MedicalBranch,all Quinn have put too much emphasis on
helped to revise my thinking.
Tuskegeeitself. She writes that the black
community's"mistrust[of the institutions
of medicine and public health] predated
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CulGrapevine:
2000), pp. 580-604.
ture (Berkeley: University of California
4. J.D. Hall, "'You Must Remember Press,1993), p. 3.
This': Autobiographyas Social Critique,"
12. E.M. Hammonds is completing a
Journalof AmericanHistory85 (September book on this subject.See alsoref. 10, Ham1998):439-42. Hall'sarticlehasan excellent monds, "TheLogicof Difference."For anintroductionto the memorydebatein the other
perspectiveon blood, rumor, and
text and footnotes.
racism,see S. Love, One Blood:The Death
5. This is most clearlyargued in J.H. and Resurrection
of CharlesR. Drew(Chapel
Jones,BadBlood:TheTuskegee
SyphilisStudy Hill: Universityof North CarolinaPress,
(New York:FreePress,1981, rev.ed. 1992) 1996).
andin T.G. BenedekandJ. Erlen,"TheSci13. H.K. Bhabhauses the phrase"ideoentificEnvironmentof the TuskegeeStudy
constructionof otherness."See "The
logical
in Biol- Other
of Syphilis,1920-1960,"Perspectives
Question:The Stereotypeand Coloogy and Medicine43 (Autumn 1999): 20. nialDiscourse,"Screen24 (1983):4, quoted
The existenceof the JohnA. AndrewHos- in K. Mercer,Welcome
to theJungle:New Popital at TuskegeeInstitutewas also of im- sitionsin BlackCulturalStudies(New York:
port,makingthe clinicalworkpossible.
Routledge,1994), p. 176. Bhabhasees this
6. The accuracyof the Wassermanntest fixity as "an importantfixtureof colonial
especiallygiven the ways the resultswere discourse."But it is also true for "internal
collectedin theAlabamaheatandsentoff to colonial"discoursesas well.
PHS laboratories,
is yet anotherissueneed14. Jones makesclear,however,that the
ing furtheranalysis.Not all the men werein PHS physicianshe intervieweddid not see
the latency stage, although the PHS re- themselvesas Nazis.
J. Jones,Personalcomsearchersclaimed to have providedtreat- municationto author,
May 1998.
ment for thosestill infectious.
For
a
of this see ref. 5,
discussion
15.
7. See ref.5, Jones,BadBlood;ED. Gray, Jones,Bad Bloodand ref. 2, the corresponThe Tuskegee
SyphilisStudy:The RealStory dence reprintedin Reverby,ed., Tuskegees
and Beyond(Montgomery,Ala.: BlackBelt Truths, 73-115.
pp.
Press, 1998); see ref. 2, Reverby, ed.
16. Seeref.5, Jones,BadBloodandref.7,
Truths.
Tuskegees
Gray,TheTuskegee
SyphilisStudy.See ref.2,
Truths,pp. 321-98,
Reverby,ed. Tuskegees
Meetings in Birmingham, Alabama, the
MIT Race and Science Colloquium,
the William Rogers Health Policy
Forum at Cornell University Medical
School, the NYU Summer Program on
Medical Ethics before Regulation, and
the Paterson Memorial Lecture in the
Medical Humanities, University of
HASTINGS CENTER REPORT 27
for differinghistoricalaccountson Nurse
Rivers, the African-Americannurse who
servedas the go-betweenfor the men and
the PHS.
17. Patient recordsfrom the Tuskegee
SyphilisStudy lawsuit,Office of Professor
David Rothman,School of PublicHealth,
ColumbiaUniversity.I am gratefulto ProfessorRothmanand ColumbiaLawSchool
Professor Hal Edgar for making these
recordsavailableto me.
18. Interviewwith Dr. RobertStory,January 1995, Tuskegee,Alabama.Dr. Story
told the exactsamestoryon an ABC Prime
Timestoryon the studyin 1993.
19. See ref. 2, S. Reverby,"Rethinking
the TuskegeeSyphilisStudy:Nurse Rivers,
Silenceand the Meaningof Treatment,"
in
Truths,pp. 365-85;
Reverby,ed., Tuskegees
see also testimonyby H. Shaw,"Testimony
of Four Survivors," in Reverby, ed.,
Truths,p. 144. R. White linksthe
Tuskegees
non-treatmentof oldermen with latelatent
syphilisin the 1940'swith Mr.Shaw'smemory of beingturnedawayin Birminghamto
arguethathe mayhavebeenturnedbackas
a matterof policy,not becausehe wasin the
the Tuskegee
study;see White, "Unraveling
of
Untreated
Archives
Study
Syphilis,"
of InternalMedicine160 (2000): 585-98.
20. In 1974, Dr. Smith was suffering
from advanceddementiaand could not be
interviewed by the federal investigating
committee.Dr. Dibbledied in 1968.
21. Data frompatientrecords,Rothman
office.
22. On the role of "accidental"penicillin's affect on other diseasesincluding
syphilis,especiallyin the 1950s, see WE.
Danehower,U.M. Hober,and B.W. Jenkins, "Penicillin Fallout . . . Menace or
Manna?"ThePennsylvania
MedicalJournal
65 (1962): 572-73.
23. P.J.Pesareet al., "UntreatedSyphilis
in the MaleNegro,"Journalof Venereal
DiseaseInformation
27 (1946):202; S.H. Schuman et al., "UntreatedSyphilisin the Male
Negro," Journal of Chronic Diseases 2
(1955): 551; D.H. Rockwellet al., "The
Tuskegee Study of Untreated Syphilis,"
Archivesof InternalMedicine114 (1961):
797.
24. Fora list of the men'snames,see ref.
7, Gray,TheTuskegee
SyphilisStudy.
28
HASTINGS CENTER REPORT
25. See ref. 2, M. Solomon [Watson],
"TheRhetoricof Dehumanization,"
in ReTruths,pp. 251-65.
verby,ed., Tuskegees
26. See ref. 19, White, "Unraveling";
See
ref. 5, Benedekand Erlen,"ScientificEnvironment."Benedekalso wrote a 1978 crisee ref.
tique of the Study'shistoriography;
2, T. Benedek, "The 'TuskegeeStudy' of
Syphilis:Analysisof MoralversusMethodologic Aspects,"reprintedin Reverby,ed.
TuskegeesTruths,pp. 213-35. White authoredan editorialopposingthe presidential apology,"GrandDragonor Windmill:
Why I Opposed the PresidentialApology
for the TuskegeeStudy,"Journalof theNationalMedicalAssociation
89, no. 11 (1997):
719-20. Both White and Benedek are
physicians;Erlenis a historianandlibrarian.
I am herelimiting,for reasonsof spaceand
coherence,my critiqueof these artides to
the question whether treatment was
diffrentforwhites.
27. The White and Benedekand Erlen
articlessurveymuch of this medicalliteratureon the penicillindebate,but not all of
it. Accordingto physicianGeorgeReeder,
penicillinwas given commonlyat Cornell
UniversityMedicalCenterto patientswith
late latent syphilisand suspectedaoritisas
early as 1946. George Reeder, Personal
communicationto author,30 May 2000,
CornellUniversityWilliam RogersHealth
PolicyForum.I havealso been told this by
otheroldersyphilologists.See alsoG. Reeder et al., "ThePrognosisof SyphiliticAortic
Annalsof InternalMedicine
Insufficiency,"
27 (1947): 584-95. Jones argues in Bad
Bloodthateventhe PHSwasgivingit out to
exceptwith a positiveblood test by the late
1940s, anyone of course the men in the
study.
28. The studywashaltedonly afterPeter
Buxton,a formerCDC venerealdiseasecase
workerdeeplytroubledaboutthe studyand
unableto get the CDC to act, gave informationon the studyto JeanHeller,an AssociatedPressreporter.The story brokein
July 1972.
29. The classicexampleof this, oftendismissedby historians,is the articleby Southern physicianR.H. Kampmeier,first publishedin 1972, "TheTuskegeeStudyof Untreated Syphilis," reprinted in Reverby,
Truths,pp. 193-201. Less often
Tuskegees
cited is the 1974 articleby AfricanAmeri-
can physicianC.J. McDonald,"The Contributionof the TuskegeeStudyto Medical
Knowledge," reprinted in Reverby,
Truths,pp. 202-12.
Tuskegees
30. See ref. 19, White, "Unraveling,"
p.
587; W.A. Hinton, Syphilisand its Treatment(New York:Macmillan,1936). White
is correctthat Jones in Bad Blooddid not
referenceHinton'swork.This criticismwas
also made by historianB. Rosenkrantzin
her reviewof Jones'book, "Non-Random
Events,"in Reverby,ed., Tuskegees
Truths,
pp. 236-47.
31. H.L. Blumand C.W. Barnett,"Prognosisin LateLatentSyphilis,"
Archives
oflnternalMedicine82 (1948):p.393.
32. See ref. 19, White, "Unraveling,"
p.
595.
33. I am gratefulto the firstanonymous
readerof this paper for the term "moral
shelter."
34. I. Clenndinnen,Readingthe Holocaust (New York: Cambridge University
Press,1999), p. 88.
35. See ref.31, BlumandBarnett,"Prognosisin LateLatentSyphilis,"pp. 395, 399,
407-408.
36. J.H. Lewis, TheBiologyof the Negro
(Chicago: University of Chicago Press,
1942).
37. For moreon the constructionof scientific facts, especiallyin syphilis,see the
classicargumentmade in L. Fleck, Genesis
and Development
of a ScientificFact(Chicaof
go: University ChicagoPress,1935, 979).
38. I wish to thank EvelynnM. Hammonds for her discussionswith me on this
crucialpoint.
39. HistorianJ. Jonesis labeled"biased"
by Dr. White.Jones,in turn,claimsWhite
the medicalevidenceto
has "cherry-picked"
fit his argument.J. Jones,personalcommunicationto author,4 May 2000. Jonescites
anotherseriesof articleson racializedviews
of syphilisin BadBloodthat arenot citedby
Benedekand Erlenor by White.
40. See ref. 1, Crane,"Writingthe Individual Back into Collective memory,"p.
1364.
41. D. Blight, Race and Reunion:The
CivilWarin American
Memory(Cambridge:
HarvardUniversityPress,2001), pp. 3-4.
September-October 200 1