*157 A. The Institutions - In Black and White

There is a fundamental question that should be posed when reconsidering a historical event such as the Tuskegee Syphilis Study: “How could this episode, requiring the collaboration of doctors, county and state health departments, draft boards, and the U.S. Public Health Service, ever have occurred? As noted historian Allan Brandt suggests, the Tuskegee study must be understood with regard to the “essentially racist nature of the experiment.” The horrific nature of the study, along with its intended and collateral consequences, is “especially appalling because it was officially sanctioned by the federal government and involved life or death situations for several hundred United States citizens.” Brandt argues that, [t]he experiment was based upon two essentially racists precepts. First, the doctors who designed the study believed that virtually all southern blacks were infected.

A closer examination of the institutions involved, the U.S. public health care system, the parties affected, and the location of the Tuskegee Syphilis experiment supports an accepted practice of “scientific racism that pervades American health institutions, historically and contemporaneously, and reflects the devaluation of Black human rights and lives in the health system.”

The federal government's effort to address venereal disease, including syphilis, began in response to the returning veterans from World War I. Treatment for syphilis that would reach poor, rural communities such as Macon County, Alabama came in the form of an alliance between the *158 philanthropic Rosenwald Fund and the U.S. Public Health Service (PHS), which sought to “expand medical services to the poorest African American areas of the South.”

The Rosenwald Fund division that supported syphilis-control demonstration programs was established in November 1929. The Rosenwald Fund's connection to the Tuskegee Institute (now Tuskegee University), was seldom discussed in the broader context of the Tuskegee Syphilis Study, but played an important role in regards to the level of trust within the community surrounding free medical treatment from doctors during health demonstrations. In January 1930, the Fund began demonstration programs in Macon County, Alabama and five other sites recommended by the PHS. The initial experiment funded by Rosenwald exemplified the greatest kindliness. The result of the Rosenwald Study confirmed that mass treatment could be successfully implemented among rural blacks.

In May 1930, Dr. H.L. Harris, Jr., a Black physician employed by the *159 Rosenwald Fund, conducted a site visit to evaluate the syphilis control demonstrations and reported that the people “were entirely ignorant of the character of disease for which they were being treated.” It appears that “[p]ublic health officials announced that they had come to test people for “bad blood.” First-hand accounts from individuals indicate that “bad blood” was an accepted term in the community that referred to many different ailments - without any social embarrassment of a disease. In fact, among the over 600 families that Johnson interviewed for his book, Shadow of the Plantation, there was no connection of syphilis to a sexual act. The condition of “bad blood” was spoken of in the same manner as one speaks of having a “bad heart” or “bad teeth.”

In the Fall of 1930, Dr. Harris' second report noted that some 1,271 cases of syphilis had been brought under treatement in the six clinics that were operating in Macon County. However, by the end of the site visit, Dr. Harris did not recommend that the syphilis control demonstration in Macon County continue, because it had “accomplished practically all that can be hoped from it.” The alleged success of the Rosenwald Fund experiment lies in the eyes of the beholder. Attorney Fred Gray puts it best, “[t]he Rosenwald/Public Health Service projects during 1930-31 were almost too successful. Approximately forty thousand persons were tested for syphilis in the six counties surveyed, and 25 percent were found to be infected.”

Despite the harsh realities of Dr. Harris' final report, it appears that the notion of any treatment or care by a physician garnered a degree of benevolence from the people of Macon County. The doctors and researchers involved saw Macon County as a prime opportunity to study untreated syphilis. The men, women, and children who stood in long lines seeking treatment for their ailments maintained an “attitude of appreciation for the gesture of helpfulness which the demonstration *160 represented. . . . Many of the families [were] enthusiastic in their praise of the work being done by the clinic.” This is evidenced by comments made by a wife in a family consisting of a mother, father and ten children who received treatment: “Them shots really hoped [helped] me.” However, not every patient was as complimentary. A patient interviewed by Johnson's team criticized the bedside manner of the “government doctor” that treated him; he recounts: “‘He lay our arms down like he guttin’ a hog,' the man complained. ‘I told him he hurt me. He told me ‘I'm the doctor.’ I told him all right but this my arm.”' Overall, the Rosenwald demonstrations gained positive public support, trust for public health care treatment, and goodwill. The Tuskegee Syphilis experiment misappropriated this support, trust, and goodwill and ultimately engendered and thereby exploited the Black test subjects by misrepresenting the Study's intended purpose: not to treat their ailments but to study the effects of untreated syphilis.