Q. What do you think best explains Nurse Rivers' role in the study?

A. There is no simple answer to this question. Nurse Eunice Rivers Laurie (she married relatively late in life) was by far the most interesting health care professional in the Tuskegee Study, and I believe that race, professional hierarchies, class, and gender all played distinct and important roles in shaping her dedication and commitment to the Tuskegee Study.

Nurse Rivers, as she was known to the subjects of the Tuskegee Study for most of its forty-year history, was, above all, an African-American woman. She was born in the deep South at the turn of the 20th century when race relations in the United States were at their nadir, and she lived and worked her entire adult life in Alabama, where race formed the soul of southern culture. White supremacy was the defining feature of race relations, and Jim Crow laws ruled the land, segregating every conceivable contact between the races. Jim Crow laws were intended not simply to make African-Americans submit to white domination by force of law, but to denigrate them so completely that they would accept white supremacy and African-American inferiority as the natural order of things.

Nurse Rivers, then, grew up in a society in which African-Americans functioned as the anvil of race relations. Whites hammered down; African-Americans sustained the blows. She, along with other members of her race, was expected to accept white domination and to defer to white demands as a matter of course. Most (but not all) of the PHS physicians for whom Nurse Rivers worked on the Tuskegee Study were white, and the South's apartheid system of race relations demanded that she follow the orders she received from her white supervisors without questioning.

Yet in this instance, race was a two-edged sword. While whites did everything in their power to deny blacks their basic rights as citizens, African-Americans never accepted the moral legitimacy of Jim Crow, and they struggled to find ways to undermine segregation and move toward equal rights. In many respects, Nurse River's career illustrates this point beautifully. After she finished nursing school at the Tuskegee Institute, she landed a highly coveted job doing bona fide public health work with the Alabama Health Department. As one of the first African-Americans to gain employment in the state's public health bureaucracy, she helped to desegregate this important field of employment. Her position in the Tuskegee Syphilis Study cast her in the same role at the federal level, for she was one of the first African-American nurses to be employed by the United States Public Health Service.

Over the years, Nurse Rivers earned the respect of her white supervisors. Their letters and reports were filled with praise for her professional competence and acute human relations skills. Proving that a nurse could play an essential role in a scientific experiment, she underscored her professional status by publishing an article in a respected journal chronicling her extraordinary role in the Tuskegee Study. [FN3] Nor did her contributions go unrecognized. Although the experiment was not mentioned by name during the award ceremony, Nurse Rivers in 1958 became the third annual recipient of the Oveta Culp Hobby Award. Named after the first secretary of the Department of Health, Education, and Welfare (HEW), the award was the highest commendation HEW could bestow on an employee. Ironically, by working on the Tuskegee Syphilis Study, a thoroughly racist experiment, Nurse Rivers struck mighty blows for desegregation and made a place for herself (and, by extension, her race) in the liminal space between black professionalism and the world of white medicine.

Despite her success, Nurse Rivers had to operate within very narrow boundaries, and it was a testimonial to her singular gift for functioning in two worlds that she negotiated these boundaries with consummate skill. Like all nurses, she had to deal with the status incongruity and differential power between physicians and nurses. Within the medical profession, physicians exercised unquestioned authority, and nurses were taught to follow their orders without questioning. All of the PHS officers for whom Nurse Rivers worked were physicians, and everything in her training and professional experience taught Nurse Rivers to do as she was told. Yet within sharply delimited boundaries, Nurse Rivers found a way to make herself invaluable. As the African-American nurse charged with the responsibility of persuading African-American men to participate in a scientific experiment conducted by white physicians (with the assistance and support of black physicians), she served as both a (buffer( and a (bridge( between the subjects and the doctors, white and black. Over time, the physicians who supervised her came to respect both her professional competence and her extraordinary human relations skills.

While race relations shaped the boundaries of her professional world, Nurse Rivers also had to contend with the cultural authority of science. As a nurse, she was a clinician whose primary role within medicine was to serve as a caregiver. She understood full well that scientific discovery was crucial to medical progress and that medical researchers occupied positions of great respect and authority within the medical profession. In fact, when PHS officers first offered her a job, she worried that her clinical background had not prepared her to work on a scientific experiment, and she shared her concerns with her mentor, Dr. Eugene H. Dibble, the head of the Andrew Hospital at the Tuskegee Institute and the man who had helped train her as a nurse. Dr. Dibble told her in no uncertain terms that she was the best nurse the Tuskegee Institute had ever graduated, and he declared that whatever the PHS officers asked her to do, she could do it. Dr. Dibble also stressed how important the experiment was to science and what a wonderful opportunity it presented for white and black professionals to work together. Thus, respect for the importance of scientific research, deference to the professional authority of scientists, and the chance to make advances for black professionals within the white world of medicine all influenced Nurse Rivers' decision to accept the position.

Gender roles in American culture intensified the pressure on Nurse Rivers to do as she was told. The United States in the 1930s was very much a patriarchal society, and this was particularly true of the American South. The rules of gender established the relationship between men and women, stipulating that men had the right to exercise power and control over women. All of the physicians, both white and African-American, who served as her supervisors were males, and the South's cult of domesticity demanded that she defer to men.

Class identity also shaped the reality of Nurse Rivers' professional life. She was born into a poor, working class family, and she was extremely fortunate that education had offered her an escape hatch into middle class life. As an upwardly mobile woman, Nurse Rivers adopted the values and attitudes of middle class culture. When she was offered a job working for the PHS, the United States was in the worst economic depression in American history, and she recently had lost her job with the Alabama State Health Department due to severe budget cuts. Good jobs were hard for anyone to find in 1932, let alone an African-American nurse looking for work in a predominantly white profession. She needed a job to preserve her foothold in the middle class, the class to which she long had aspired and had worked so hard to enter. When the PHS offered her a job, it must have seemed as though Jacob's ladder had descended. Thus, hard times, economic austerity and upward mobility all conspired to make Nurse Rivers accept the position. And once she was on board, class distinctions helped to separate her from the subjects in the Tuskegee Study. In essence she identified more with middle class African-Americans than she did with working class men.

Together, then, race, professional hierarchy, gender, and class worked to pull Nurse Rivers into the Tuskegee Study. What made it easy for her to stay, however, was her heartfelt conviction that she was doing important work. Dr. Dibble (her mentor) and all of the PHS supervisors for whom she worked over the decades assured Nurse Rivers that the Tuskegee Study was an important scientific experiment that would make major contributions to medical knowledge, and all of them acted as though there was nothing ethically wrong with the study. Who was she to say otherwise?

Finally, Nurse Rivers' self-image cast her in a benevolent role, allowing her to perform her duties with a clear conscience. Her work on the Tuskegee Study, it must be stressed, occupied only about half of her time, leaving her free to devote the rest of her working days to bona fide public health assignments that greatly benefited the people she served. As she once put it, when she was not busy with the Tuskegee Study, (I was minding my mommas, my old folks and my babies.(African-American families throughout Macon County and the contiguous counties were indebted to Nurse Rivers for the vital public health work she performed in their communities, and they also had her to thank for many acts of personal kindness. The part of her career that she devoted to clinical work nurtured the caregiver in Nurse Rivers and made it possible for her to maintain a positive self-image. Over time, the two roles she performed in her career (her work on the Tuskegee Study and her duties as a public health nurse) melded in her mind, and Nurse Rivers saw herself as the nurse who took care of everyone. As she put it, working with the men in the study (was the joy of my life.