Macon County, Ala., bears a history that seems to run parallel with that of the United States itself. On the one hand it is where in 1881, Booker T. Washington chose to establish what is now the Tuskegee University, educating thousands of future Black leaders and preparing them for economic independence.

On the other hand, those same roads in Macon County in the early 1930s bore the lengthy and terrible embossed signature of racism. What happened there from 1932 to 1972, historians look at as one of the most insidious acts of brutal scientific exploitation in U.S. history. In the four decades that it took place, much of the American medical community that knew about it – including public health officials – simply looked the other way.

Why? It started out as an attempt to treat a rural Black population afflicted with a syphilis outbreak, but turned into a nefarious opportunity to exploit Black men for what government medical agents felt was sound science.

The physicians involved thought of it as beneficial to society, but what was known as the Tuskegee Study of Untreated Syphilis in the Negro Male only lives in historic infamy today.

How It Began

The roots of the Tuskegee Experiment were in many ways just as nefarious as the study itself. According to a paper written in 1978 by Harvard University historian Allan M. Brandt, between 1890 and 1910, doctors studying sexually transmitted infections (STI) in Oslo, Norway withheld treatment from almost 2,000 patients infected with syphilis, a bacterial infection known to be spread through sexual contact.  If left untreated, those infected could suffer blindness, mental health problems, heart, brain and nervous system damage, and in some extreme cases, death.

At the time, most doctors treated syphilis with Salvarsan, a drug which treats the bacterium that causes syphilis. However, the drug was found to be toxic in humans and ultimately ineffective to those who had advanced syphilis.

Doctors had already observed a syphilis outbreak in rural Alabama, and public health advocates had called for it to be addressed. In 1929, the Chicago-based Julius Rosenwald Fund, a philanthropic entity that donated money to various charitable causes, gave a grant to the United States Public Health Service (USPHS), a predecessor of several current U.S. government health agencies, to study occurrence of syphilis in Black people in the rural south. Researchers found an outbreak of the disease in Macon County – which had the highest rate of the six surveyed counties and determined it was the perfect test case for mass treatment.

The same year, the nation was suffering through the Great Depression and the funding for a treatment project collapsed. Dr. Taliaferro Clark, who authored the Rosenwald study report, was Chief of the USPHS Venereal Disease Division and felt that the Macon County cases allowed for an opportunity to observe the progression of the disease. Observers of the Oslo study believed syphilis affected Black people differently than it did White people. Syphilis can remain latent in many patients and a large number of Black men there had lived with the disease despite showing no symptoms. To Clark, this was a chance to study the natural course of the disease. He communicated his theory to then-U.S. Surgeon General Hugh S. Cumming, who thought the research could have a result on treatment.

Many in the venereal medicine field believed experimenting on Black people presented a unique opportunity given their beliefs that these men were typically poor, uneducated, promiscuous, and unlikely to seek medical treatment, and as much so was indicated in Brandt’s paper.

The study began in 1932 with medical observations of Black men in Macon County, which had a 40 percent prevalence rate of syphilis. Latency and lack of treatment could have been a possible explanation, but the number of noninfectious cases as opposed to infectious cases was not known. Nonetheless, the occurrence of syphilis was very high there at the time.

At the beginning, about 30 percent of the men were aged 50 or older.  Most were poor farmers and sharecroppers who had lived with syphilis for as long as 20 years. Few had access to health care and even so, Jim Crow culture all but barred them from seeking care at major medical facilities.

The one place in the area where health care professionals were being trained was the then-Tuskegee Institute. With the prevalence of syphilis in the area, widely known among scientists under the guidance of Cumming, the U.S. Public Health Service began to work with the school with an intent to monitor patients for a period of six to eight months.

The campus had already established a hospital and nurse training school (later named the John A. Andrew Memorial Hospital). It was easy enough to get participants through fliers that had been passed out in the area which promised free blood tests and medical treatment for what was called “bad blood.” Just like the word “sugar” is classically used to refer to diabetes in Black culture, “bad blood” was a local colloquialism for syphilis, among other ailments. They were promised health care and burial insurance in return for their participation. A total of 600 men were registered to participate: 399 who were diagnosed with syphilis, and a control group of 201 who did not have the disease was also chosen.

Charlie Pollard, was a young farmer in Macon County at the time and was one of those recruited. Testifying to a U.S. congressional subcommittee years later, he described how he joined the study.

“They came around and give us the blood tests,” he said. “After they give us the blood tests, all up there in the community, they said we had ‘bad blood.’ After then they started giving us the shots and they started giving us the shots for a good long time. I don’t remember how long it was. But after they got through giving us those shots, they give me a spinal tap. That was along in 1933.”

It is unclear exactly what those shots were before the spinal taps, but one participant called them “606 shots,” which was a slang term for Salvarsan.  The painful taps, however, helped the doctors to obtain spinal fluid for neurosyphilis testing. Pollard testified that for the duration of his decades in the study, the only compensation he ever received was $25 and a certificate, which he got in 1958.

What Was In It For the U.S. Government?

The question medical scientists involved in the Tuskegee Study were trying to resolve is whether or not syphilis, in its later stages, was more likely to result in cardiovascular disease in Blacks than in Whites.

Another serious question in the minds was to examine how the disease behaved in African American populations. For much of America’s history, medical scientists have mistreated Black communities in the belief that diseases present differently in Black bodies than in White ones. For example, in 1793, doctors treating White patients in Philadelphia during an outbreak of yellow fever believed that Black patients were immune to it.

With the Tuskegee Study, doctors falsely believed that while Black people carried the disease with frequency, it had little impact on their overall health. Ironically, the initial intent of the Rosenwald Fund was to show that syphilis was as much of a problem for Black populations as it was for White ones. Further, after their deaths autopsies could be performed to show the extent of how untreated syphilitic infection actually impacted Black bodies.

Under Alabama law, families had to sign consent forms for autopsies to be performed. The USPHS promised burial insurance as an incentive for their consent, according to the Milbank Fund, which provided the monies for the burials when the Rosenwald Fund’s cash dried up (the organization would later apologize in June 2022 for its role).

It wasn’t the government that spoke directly to the men involved. Instead, in partnership with health care professionals at Tuskegee, intermediaries from the school were enlisted to go-between the men and the government doctors. The most noted was a nurse named Eunice Rivers. Educated at Tuskegee and spending her career in that community, she was brought in by the doctors to serve as one of the liaisons.

The 1992 stage play, and the 1997 HBO film “Miss Evers Boys” was based on Rivers’ involvement in the study and her relationship with the men who participated. The film was nominated for 11 Emmy Awards and won four.

Historians debate Rivers' role in the Tuskegee Study. Some say she was simply a nurse following the orders, never really knowing the real intention of the work being done, and even believing she was helping to contribute to science by getting these men care they would otherwise never receive. Indeed, she did become familiar with the men, many of them socializing together as a group called “Miss Rivers Lodge” when doctors made their annual visits to check on them.

Others have taken a different stance, accusing Rivers of being complicit in a duplicitous machination of Black bodies that served a deliberate intent of racist exploitation. Either way, she was a Black nurse in the rural south, a profession in which there were rare opportunities for Black people to be a part of a major government scientific effort.

In her own words from a 1977 interview, Rivers said that she viewed her job as someone who gave care to patients as any nurse would.

“Honestly, those people got all kinds of examinations and medical care that they never would have gotten,” she said.

In 1936, President Franklin D. Roosevelt appointed Thomas Parran Jr., as the new U.S. Surgeon General. The decision was made to follow the participants as they remain untreated for syphilis for the remainder of their lives. Parran was an outspoken proponent of studying and finding a treatment for STIs, particularly in Black communities. As a result, the Tuskegee Study continued during his tenure as well as a  similar study which took place in Guatemala, and was supported by Parran and the USPHS at that time.

In 1941, penicillin was discovered as a workable and less toxic treatment for syphilis. Despite that, the USPHS continued the study, instructing its doctors not to administer the medicine to the patients and telling them not to seek treatment for it from other doctors who weren't involved with the study. Any who did would be removed as their benefits forfeited.

The Damage Done

Official records show that at least 28 of the 600 Black men involved died as a direct result of syphilitic infection, and another 100 died of related complications. This didn’t just touch the lives of the men who were duped into the study. Forty Black women, married to these men, were diagnosed and passed it to 19 children at birth. By 1969, the study, which was never a secret, was beginning to attract negative criticism from many in the medical community, who criticized it as unethical. Dr. Irwin Shatz, a cardiologist at Henry Ford Hospital in Detroit was among them.

He voiced his disgust directly to the administrators in charge of the study in 1965:

That letter was never answered, but others were angry enough to sound the alarm. William Jenkins, a Black USPHS statistician who joined the agency in 1967 learned of the study, discovering in fact that multiple medical journals had written about it. When he approached his supervisor in protest, he was told “don’t worry about it.”

Defiant to that response, Jenkins and a group of activists published what they had learned about the Tuskegee Study in a newspaper called The Drum, but it was never picked up by major media. Jenkins went on to have a successful career in epidemiology at the Centers For Disease Control. He died in 2019 at age 73.

In 1972, Peter Buxtun, a young venereal disease investigator also with the USPHS, learned about the Tuskegee Study and contacted the Associated Press with his findings.  The story landed with Jean Heller, a then 29-year-old investigative reporter. In an interview with BET.com, Heller said the country had experienced some tumultuous years including fallout of the multiple assassinations of the civil rights movement, urban unrest and the Vietnam War. Despite that, she said, this story needed to be told.

“It was not a story that was going to be ignored,” Heller explained. “This story had to be told whether the country was ready for it or not… I don't think there's any point in which it would have been better for the country to hear about it. And my biggest concern was getting the damn thing stopped.”

Her article, “Black Men Untreated in Tuskegee Syphilis Study,” was published July 25, 1972. Other media reports followed suit, further detailing the extent to which the men in the Tuskegee Study were exploited. The exposure lit a fire among administrators in the U.S. Department of Health Education and Welfare, and an investigation ensued. Heller said that an immediate stop was put to the study once her story broke.

An ad hoc advisory panel to Dr. Merlin Duval, then-U.S. Assistant Secretary for Health and Scientific Affairs, reviewed the 40-year record of experimentation with the men in the study.

“No convincing evidence has been presented to this panel that participants in this study were adequately informed about the nature of the experiment, either at its inception or subsequently,” the panel’s report said in its recommendation that the study be terminated immediately.

On November 16, 1972, the Department of Health Education and Welfare ordered the Tuskegee Study terminated. By March 1973, Caspar Weinberger, who had become the agency’s Secretary under President Nixon, directed that the participants be given proper health care and treatment for the rest of their lives.

A Long Aftermath

In 1973, a civil case was filed against the U.S. government by attorney Fred Gray on behalf of Pollard. Other men involved in the study later joined as part of a class action lawsuit. By this time, many of the original participants had died, and many others were difficult to locate due to shoddy recordkeeping. Gray, a Montgomery-based lawyer, was best known as the attorney who represented Rosa Parks after she was removed from a bus and arrested in 1955, sparking the Montgomery Bus Boycott.

The same year, Sen. Edward M. Kennedy called congressional hearings that addressed human experimentation in medicine. Gray, speaking for the survivors, harshly indicted the USPHS for conducting the study, saying that they deliberately withheld treatment from these Black men, even when a cure was readily available..

“The participants in this study are firmly convinced that the United States government in the manner in which this study was conducted, violated their constitutional rights,” he said. “They feel that the government knew they had syphilis and failed to treat them.

“We think…,” Gray continued, “the study was racially motivated and it discriminated against Blacks in that no Whites were selected to participate in the study and only those recruited were poor, uneducated, rural Blacks.”

In a settlement, the government awarded the survivors who joined the lawsuit and their heirs a total of $10 million and an agreement to pay for their future medical care. In 1974, Congress passed the National Research Act and informed consent became a standard medical requirement which had to now be overseen by hospital institutional review boards.

In 1997, the last living survivors or their families assembled at the White House as President Bill Clinton issued a formal apology for what they had been put through. Herman Shaw, who was then 94, spoke for those still living and those who died as a result of their participation.

“The wounds that were inflicted upon us cannot be undone,” he said. “I’m saddened today to think of those who did not survive and whose families will forever live with the knowledge that their deaths and suffering was preventable.

“The damage done by the Tuskegee Study,” he continued, “is much deeper than the wounds any of us may have suffered.”

In 1999, Tuskegee University launched the National Center for Bioethics in Research and Health Care with an initial $200,000 grant from the government. Since then, more than $20 million has been contributed to the center by government and private entities.

The last survivor of the Tuskegee Study, Ernest Hendon, died in 2004  at age 96.

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Next Week: Continue to follow BET.com News Special,“The Tuskegee Experiment 50 Years Later” with audio of the original 1977  interview with Eunice Rivers Laurie, the Tuskegee nurse who administered care to the participants and an interview with the granddaughter of one of the Black men victimized by the Tuskegee Study.