Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Week 5.  Carnalities

"Syphilis Victims ... Went Untreated for 40 Years"
from The New York Times (July 26, 1972)
by Jean Heller

Washington, July 25 [1972] -- For 40 years the United States Public Health Service has conducted a study in which human beings with syphilis, who were induced to serve as guinea pigs, have gone without medical treatment for the disease and a few have died of its late effects, even though an effective therapy was eventually discovered.

Officials of the health service who initiated the experiment have long since retired.  Current officials, who say they have serious doubts about the morality of the study, also say that it is too late to treat the syphilis in any surviving participants.

Doctors in the service say they are now rendering whatever other medical services they can give to the survivors while the study of the disease's effects continues.

Dr. Merlin K. DuVal, Assistant Secretary of Health, Education and Welfare for Health and Scientific Affairs, expressed shock on learning of the study.  He said that he was making an immediate investigation.

The experiment, called the Tuskegee Study, began in 1932 with about 600 black men, mostly poor and uneducated, from Tuskegee, Ala., an area that had the highest syphilis rate in the nation at the time.

Four hundred of the group had syphilis and never received deliberate treatment for the venereal infection.  A control group of 200 had no syphilis and did not receive any specific therapy.

Some subjects were added to the study in its early years to replace men who had dropped out of the program, but the number added is not known.  At the beginning of this year, 74 of those who received no treatment were still alive.

As incentives to enter the program, the men were promised free transportation to and from hospitals, free hot lunches, free medicine for any disease other than syphilis and free burial after autopsies were performed.

Could have Been Helped
The Tuskegee Study began 10 years before penicillin was found to be a cure for syphilis and 15 years before the drug became widely available.  Yet, even after penicillin became common, and while its use probably could have helped or saved a number of the experiment subjects, the drug was denied them, Dr. J. D. Millar says.

Dr. Millar is chief of the [venereal] disease branch of the service's Center for Disease Control in Atlanta and is now in charge of what remains of the Tuskegee Study.  He said in an interview that he has serious doubts about the program.

Dr. Millar said that "a serious moral problem" arose when penicillin therapy, which can cure syphilis in its early stages, became available in the late nineteen-forties and was withheld from the patients in the syphilis study.  Penicillin therapy became, Dr. Millar said, "so much more effective and so much less dangerous" than pre-existing therapies.

The study began when attitudes were much different on treatment and experimentation."  Dr. Millar said.  "At this point in time, with our current knowledge of treatment and the disease and the revolutionary change in approach to human experimentation, I don't believe the program would be undertaken."

Members of Congress reacted with shock to the disclosure today that the syphilis experimentation on human guinea pigs had taken place.

'A Moral Nightmare'
Senator William Proxmire, Democrat of Wisconsin, a member of the Senate Appropriations subcommittee that oversees Public Health Service budgets, called the study "a moral and ethical nightmare."

Syphilis is a highly contagious infection spread by sexual contact.  If untreated, it can cause bone and dental deformations, deafness, blindness, heart disease and deterioration of the central nervous system.

No figures were available as to when the last death in the program occurred.  One official said that no conscious effort was apparently made to halt the program after it got under way.

A 1969 study of 276 untreated syphilitics who participated in the Tuskegee study showed that seven had died as a direct result of syphilis.  The 1969 study was made by the Atlanta center, whose officials said they could not determine at this late date how any additional deaths had been caused by syphilis.

However of the 400 men in the original syphilitic group, 154 died of heart disease that officials in Atlanta said was not specifically related to syphilis.  Dr. Millar said that this rate was identical with the rate of cardio-vascular deaths in the control, or non-syphilis, group.

Dr. Millar said that the study was initiated in 1932 by Dr. J. R. Heller, assistant surgeon general in the service's venereal disease section, who subsequently became division chief.

Of the decision not to give penicillin to the untreated syphilitics once it became widely available, Dr. Millar said, "I doubt that it was a one-man decision.  These things seldom are.  Whoever was director of the VD section at that time, in 1946 or 1947, would be the most logical candidate if you had to pin it down."

'Never Clandestine'
The syphilis study "was never clandestine" and 15 scientific reports were published in the medical literature, Dr. Millar said in a telephone interview yesterday from Atlanta.

Officials who initiated the study in 1932 had informed the syphilis victims that they could get treatment for the infection at any time, Dr. Millar said.

"Patients were not denied drugs," Dr. Millar stressed.  Rather, they were not offered drugs.

When the study began, doctors could offer only what is now regarded as poor therapy--injections of metals like bismuth, arsenic and mercury.  Such treatments were known to be toxic.

Many doctors, Dr. Mill[a]r said, then thought "it better not to treat syphilis cases because of the mortality from" the metal therapies.

The critical period in ethics was in the late nineteen[-]forties and early nineteen-fifties when antibiotics could have been but were not prescribed for the syphilis patients.

Go to:
  • "Survivor of '32 Syphilis Study Recalls a Diagnosis" (July 27, 1972), by James T. Wooten
  • The Belmont Report (1979), by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
  • Presidential Apology (1997), to African-American participants in the "Tuskegee Study of Untreated Syphilis in the Negro Male"
  • "U.S. Apologizes for Syphilis Tests in Guatemala" (October 1, 2010), by Donald G. McNeil, Jr. with contributions from Elisabeth Malkin
Weekly Readings
Lecture Notes