The Tuskegee Syphilis Study was a research study conducted between 1932 and 1972 in rural Alabama. During the study, researchers from the United States Public Health Service intentionally withheld medical treatment from 400 Black men who had been infected with syphilis, with the stated aim of documenting the effects of the disease on their bodies and performing autopsies on the men. The exposure of the study in 1972 shocked the nation. More than fifty years later, its impact upon public health continues. Keep reading, as we use publications from university presses on HeinOnline to explore forty years of malpractice and deception, and the continued influence of the Tuskegee Syphilis Study today.

A History of Experimentation

The Tuskegee Syphilis Study was not without precedent. There is a well-established history of unethical medical experimentation upon Black Americans in the United States. The modern practice of gynecology began with nonconsensual experiments performed upon Black women. The physician J. Marion Sims, sometimes referred to as the “father of gynecology” developed the vaginal speculum and a number of surgical techniques by experimenting on three enslaved Black women, named Anarcha, Betsey, and Lucy. Sims subjected the women to surgery without anesthesia, causing irreversible harm to the three women, as he refined surgical techniques that would be used primarily for the benefit of white patients.

More recently, and contemporaneous with the Tuskegee Syphilis Study, is the case of Henrietta Lacks. Lacks, a Black woman, was admitted to Johns Hopkins University Hospital in 1951 with cervical cancer. Before her death later that same year, doctors at the hospital harvested cancer cells from a tumor in her body, without her consent and unbeknownst to her family. Doctors found that the cells harvested from Lacks reproduced rapidly and indefinitely under laboratory conditions, making them ideal for medical and industrial research. These cells, which were designated as “HeLa cells,” were mass produced and used for research that generated millions of dollars in profit for pharmaceutical companies and other institutions, without her family receiving any compensation, or even learning of what happened to their ancestor until decades later. The story of Henrietta Lacks, her family, and the cell line that bears her name was the subject of science journalist Rebecca Skloot’s The Immortal Life of Henrietta Lacks, published in 2010, as well as a subsequent biopic adaptation of the same name.

“The results of this study will be sought the world over.”

One remarkable aspect of the Tuskegee experiment is that it was a longitudinal study, meaning that the same group of participants was tracked and studied over a period of years; in this case, forty years, stretching from 1932 to 1972. This entailed four decades of coercion, collusion, and deception on the part of successive generations of scientists and medical professionals, as they worked to keep the men in the study, and to ensure that the men of Macon County did not receive treatment for their affliction.

The Tuskegee Syphilis Study was a complex project which had to be coordinated between multiple institutions: the Tuskegee Institute, Alabama state health authorities, and federal health authorities in the United States Public Health Service. This was all documented in letters, exchanged between administrators and clinicians in Alabama and Washington, D.C. These letters, and other primary documents including first-hand interviews, can be found in one of the more intriguing titles in HeinOnline’s Civil Rights and Social Justice Collection: Tuskegee’s Truths: Rethinking the Tuskegee Syphillis Study, edited by Susan M. Reverby.

As one reads through the letters collected in Tuskegee’s Truths, it is impossible not to notice the competing motivations and reservations of the participants in the study, and the ways in which interests alternately diverge and converge according to racial, ethnic, and professional divisions. For researchers and administrators at the Tuskegee Institute, participation in the study represented access to resources from the federal government, and an opportunity to lend prestige to the historically Black institution which was keen to position itself on the cutting edge of medical research. Eugene H. Dibble, the chief medical officer at the Tuskegee Institute and an early proponent of the project, wrote in a memo to R.R. Moton, Principal of the Tuskegee Institute, that participation would offer “valuable training for our students as well as for the Internes” and “our own hospital and Tuskegee Institute would get credit for this piece of research work…the results of this study will be sought after the world over.”

Pressure to participate in the study also came from the highest ranks of the federal public health service. Later in 1932, H.S. Cummings, the United States Surgeon General, further implored Moton in a letter to consent to the use of the Tuskegee Institute’s facilities and staff in the study: “I shall be grateful if you extend the splendid cooperation offered by Doctor Dibble contingent on your approval…the success of this important study really hinges on your cooperation.” Moton consented, and the Tuskegee Syphilis Study commenced in 1932, as a collaborative project between local—predominantly Black—researchers and medical professionals, and federal public health officials—who were exclusively white, and based out of state.

“Some treatment”

Correspondence between these researchers and administrators reveals that, from the start, the project was characterized by a tension between the desire of researchers to maintain an undiluted pool of test subjects, and the ethical imperative of medical practitioners to provide care to these test subjects, who were members of their community suffering from debilitating illness. The necessity for deception further complicated matters, with the people of Macon County inclined already to be mistrustful of out-of-state public health officials. R.A. Vonderlehr, the head of the Center for Disease Control and Prevention and head of the project in its early years lamented, in a letter to a colleague in 1938: “it was difficult to hold the interest of the group of Negroes in Macon County unless some treatment was given.” In the early years of the study, “some treatment” often amounted to little more than packets of vitamins and aspirin, which alleviated minor aches and pains but did nothing to treat their underlying condition.

As the study progressed, public health officials became increasingly preoccupied with preventing the men of Macon County from receiving treatment for syphilis, lest their study be deprived of human test subjects. World War II complicated matters, as many of the men of Macon County found themselves drafted into the Army. The Army tested potential draftees for syphilis, and treated those who it found were infected. This prompted administrators from the U.S. Public Health Service to provide the local draft board with “a list containing 256 names of men under 45 years of age and [ask] that these men be excluded from the list of draftees needing treatment.“

The Complicated Role of Nurse Rivers

Things became more complicated after 1947, when penicillin became widely available. The antibiotic killed the bacteria that caused syphillis, and was an effective treatment at all stages of the disease. The antibiotic was available at public health clinics in the nearby city of Montgomery. Increasingly, federal public health officials relied heavily on the local knowledge and expertise of the Black researchers and medical practitioners at the Tuskegee Institute, not only to administer and process the results of the bloodwork and other tests performed on the men, but to keep the men enrolled in the study and prevent them from seeking effective treatment for syphilis elsewhere.

The task of holding the project together fell on the shoulders of Eunice Rivers Laurie, a Black nurse who was the only staff member involved in the entirety of the project from its inception in 1932 to its abrupt cessation in 1972. Nurse Rivers, as she was universally referred, was well respected in the community, and by all accounts cared deeply for the men she was entrusted with. Susan M. Reverby discusses the work of Nurse Rivers, and her complicated legacy, in depth in a dedicated chapter from another title from University of North Carolina Press, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. Reverby emphasizes the increasing importance of Rivers in the study over time: “As the Study progressed, Rivers was given more responsibility. She drove the men into Tuskegee for examinations and x-rays, did the follow-ups, drew blood in the field, took in the urine specimens, helped in their assessment and in the provision of tonics and analgesics, assisted at the spinal taps, created the camaraderie that kept them in the Study, and encouraged the families to allow autopsies by promising and providing money for burials.”

Despite this, Nurse Rivers and other Black professionals participating in the study faced contempt and discrimination from their white colleagues. In an exchange between two employees of the U.S. Public Health Service, one Eleanor N. Walker expresses the contemptuous attitudes many of the white researchers held toward the dying men in Macon County as well as their own colleagues: “I have never felt that Nurse Rivers was an adequate ‘‘policeman’’ for these people. I know the colored people in the South and one shouldn’t expect 100% effort from any of them unless they are under constant supervision. In a community of this type where everyone knows everybody’s business I can’t see how we could have lost from contact so many of the group if Nurse Rivers had been even moderately interested in perpetuating the study.”

Reverby and other historians of the study often view Nurse Rivers, and Eugene Dibble—the medical director of the Tuskegee Institute, who lobbied for its participation in the study—in a sympathetic, if conflicted, light. Reverby writes, in Examining Tuskegee: “Just as Dibble thought of himself as a “race man,” Rivers thought of herself as a “race woman,” concerned about advancing the rights of African Americans.” Reverby goes so far as to speculate that Rivers may have discreetly helped some of men in the study to receive antibiotics and treatment for syphilis, although this is never something Rivers herself admitted outright. Whether or not Rivers directed some study participants to clandestine treatment (as Eleanor Walker seemed to perhaps suspect, in her correspondence above), the fact that she provided genuine care and assistance to the men is something that virtually all attested to. As Reverby writes: “No one seemed to doubt that Eunice Rivers Laurie cared for the men she recruited and helped to keep in the Study. She evinced trust and respect. “Oh my God, she was their mama,” Emma Cooper, the daughter of one of the men in the Study, remembered. Indeed, this is what seems so troubling in her legacy.“

The Tuskegee Syphilis Study Exposed

By the 1960s, the Tuskegee Syphilis Study was well known within the medical community, and physicians and other medical workers began to express doubts and concerns about the ethics of the project amongst themselves. In 1965, Dr. Irwin J. Schatz wrote to Donald H. Rockwell, a physician with the U.S. Public Health Service’s Venereal Disease Research Laboratory in Atlanta: “I have recently read your paper on the Tuskegee Study of Untreated Syphillis…I am utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is available. I assume you feel that the information which is extracted from observation of this untreated group is worth their sacrifice. If this is the case, then I suggest that the United States Public Health Service and those physicians associated with it in this study need to re-evaluate their moral judgements in this regard.” In 1966, Peter Buxtun, an epidemiologist with the U.S. Public Health Service filed a complaint with the organization’s ethics division, which was rejected. He protested again in 1968, pointing out not only the ethical failures of the study but the social and political ramifications of a group of white doctors withholding treatment from Black men infected with a curable disease.

Despite these protests, the study remained an open secret in the medical profession through the end of the 1960s. Peter Buxtun, a man of Jewish descent who fled Nazism in Europe with his family as a child, was enraged by the study, which he compared to the Nazi medical experiments in the Dachau concentration camp, reportedly much to the chagrin of his colleagues. Fed up with the lack of concern from public health authorities, Buxtun leaked information about the study to the Associated Press in 1972. On July 25, 1972, the Washington Star published an exposé of the study; the following day, it appeared on the front page of the New York Times.

Senator Ted Kennedy quickly convened a series of hearings in Congress, in which Buxtun, public health officials, and citizens from Macon County delivered testimony. The study was terminated shortly thereafter. At the time of the study’s termination, 74 of the original 399 men with syphilis were still alive. Additionally, 40 of their wives had been infected with syphilis by this time, and 19 children had been born with congenital syphilis.

Following a class action suit by the NAACP, in 1974 the federal government distributed compensation and provided for the medical care of survivors of the study. The same year, Congress passed the National Research Act, which established informed consent standards for research studies involving human participants.

In 1997, President Bill Clinton issued a formal apology to the surviving subjects of the study. The last survivor of the study, Ernest Hendon, died in 2004. Nevertheless, its legacy looms large over the United States, where Black Americans continue to face disproportionately negative health outcomes in institutional settings. In a Pew Research Study conducted in 2024, a majority of Black Americans state that the U.S. healthcare system was designed to hold Black people back.

University Presses on HeinOnline

The two books that form the centerpiece of this post, Examining Tuskegee and Tuskegee’s Truths were published by the University of North Carolina Press. University presses occupy an important role in the publishing ecosystem, providing a place for specialized research-intensive scholarship that is often overlooked by commercial presses. HeinOnline is proud to host more than 400 current and historical titles from the University of North Carolina Press in our dedicated collection, UNC Press Law Publications. The titles in this collection place a special emphasis on research into the history of civil rights and social justice. Additional university press publications, from Oxford University Press, the University of Toronto Press, and many others are also available throughout HeinOnline.