Under the Shadow of Tuskegee: African Americans and Health Care Vanessa Northington Gamble, MD, PhD Introduction foundation for today's pervasive sense of black distrust ofpublic health authorities."6 On May 16, 1997, in a White House The syphilis study has also been used to ceremony, President Bill Clinton apolo- explain why many African Americans gized for the Tuskegee Syphilis Study, the oppose needle exchange programs. Needle 40-year government study (1932 to 1972) exchange programs provoke the image of in which 399 Black men from Macon the syphilis study and Black fears about County, Alabama, were deliberately genocide. These programs are not viewed denied effective treatment for syphilis in as mechanisms to stop the spread of order to document the natural history of HIV/AIDS but rather as fodder for the drug the disease.' "The legacy of the study at epidemic that has devastated so many Tuskegee," the president remarked, "has Black neighborhoods.7 Fears that they will reached far and deep, in ways that hurt our be used as guinea pigs like the men in the progress and divide our nation. We cannot syphilis study have also led some African be one America when a whole segment of Americans with AIDS to refuse treatment our nation has no trust in America."2 The with protease inhibitors.8 president's comments underscore that in The Tuskegee Syphilis Study is fre- the 25 years since its public disclosure, the quently described as the singular reason study has moved from being a singular behind African-American distrust of the historical event to a powerful metaphor. institutions of medicine and public health. It has come to symbolize racism in medi- Such an interpretation neglects a critical cine, misconduct in human research, the historical point: the mistrust predated pub- arrogance of physicians, and government lic revelations about the Tuskegee study. abuse ofBlack people. Furthermore, the narrowness of such a rep- The continuing shadow cast by the resentation places emphasis on a single his- Tuskegee Syphilis Study on efforts to torical event to explain deeply entrenched improve the health status of Black Ameri- and complex attitudes within the Black cans provided an impetus for the campaign community. An examination of the syphilis for a presidential apology.3 Numerous study within a broader historical and social articles, in both the professional and pop- context makes plain that several factors ular press, have pointed out that the study have influenced, and continue to influence, predisposed many African Americans to African Americans' attitudes toward the distrust medical and public health authori- biomedical community. ties and has led to critically low Black Black Americans' fears about exploi- participation in clinical trials and organ tation by the medical profession date back donation.4 The specter of Tuskegee has also been raised with respect to HIV/AIDS preven- The author is with the History of Medicine and tion and treatment programs. Health educa- Family Medicine Departments and the Center for B. Thomas and the Study of Race and Ethnicity in Medicine, tion researchers Dr Stephen University of Wisconsin School of Medicine, Dr Sandra Crouse Quinn have written Madison. extensively on the impact of the Tuskegee Requests for reprints should be sent to Syphilis Study on these programs.5 They Vanessa Nortiington Gamble, MD, PhD, University argue that "the legacy of this experiment, of Wisconsin School of Medicine, 1300 University with its failure to educate the study partici- Ave, Madison, WI 53706. pants and treat them adequately, laid the This paper was accepted July 24, 1997. American Joumal of Public Health 1773 Gamble to the antebellum period and the use of operation was not successful, and Sims last drop of blood from the victim, the slaves and free Black people as subjects for later attempted to repair the defect by body is dumped into some secret place dissection and medical experimentation.9 placing a sponge in the bladder. This where it is impossible for any person to Although physicians also used poor Whites experiment, too, ended in failure. He noted: find it. The colored women are so worked up over this phantom that they will not as subjects, they used Black people far The whole urethra and the neck of the trip to the venture out at night, or in the daytime in more often. During an 1835 bladder were in a high state of inflam- any sequestered place.'5 United States, French visitor Harriet Mar- mation, which came from the foreign tineau found that Black people lacked the substance. It had to come away, and there Fry did not find any documented evi- power even to protect the graves of their was nothing to do but to pull it away by dence of the existence of night riders. dead. "In Baltimore the bodies of coloured main force. Lucy's agony was extreme. However, she demonstrated through exten- people exclusively are taken for dissec- She was much prostrated, and I thought sive interviews that many African Ameri- tion," she remarked, "because the Whites that she was going to die; but by irrigating cans expressed genuine fears that they can- the parts of the bladder she recovered with would be kidnapped by night doctors and do not like it, and the coloured people great rapidity. not resist."'l Four years later, abolitionist used for medical experimentation. Fry Theodore Dwight Weld echoed Mar- Sims finally did perfect his technique concludes that two factors explain this tineau's sentiment. "Public opinion," he and ultimately repaired the fistulas. Only paradox. She argues that Whites, especially wrote, "would tolerate surgical experi- after his experimentation with the slave those in the rural South, deliberately ments, operations, processes, performed women proved successful did the physi- spread rumors about night doctors in order upon them [slaves], which it would exe- cian attempt the procedure, with anesthe- to maintain psychological control over crate if performed upon their master or sia, on White women volunteers. Blacks and to discourage their migration other whites."1' Slaves found themselves as to the North so as to maintain a source of subjects of medical experiments because cheap labor. In addition, Fry asserts that physicians needed bodies and because the Exploitation After the Civil War the experiences of many African Ameri- state considered them property and denied cans as victims of medical experiments them the legal right to refuse to participate. It is not known to what extent African during slavery fostered their belief in the Two antebellum experiments, one car- Americans continued to be used as unwill- existence of night doctors.'6 It should also ried out in Georgia and the other in Alaba- ing subjects for experimentation and dis- be added that, given the nation's racial and ma, illustrate the abuse that some slaves section in the years after emancipation. political climate, Black people recognized encountered at the hands of physicians. In However, an examination of African- their inability to refuse to participate in the first, Georgia physician Thomas American foLklore at the turn ofthe century medical experiments. Hamilton conducted a series of brutal makes it clear that Black people believed Reports about the medical exploita- experiments on a slave to test remedies for that such practices persisted. Folktales are tion of Black people in the name of medi- heatstroke. The subject of these investiga- replete with references to night doctors, cine after the end of the Civil War were tions, Fed, had been loaned to Hamilton as also called student doctors and Ku Klux not restricted to the realm of folklore. repayment for a debt owed by his owner. doctors. In her book, Night Riders in Black Until it was exposed in 1882, a grave rob- Hamilton forced Fed to sit naked on a Folk History, anthropologist Gladys-Marie bing ring operated in Philadelphia and pro- stool placed on a platform in a pit that had Fry writes, "The term 'night doctor' vided bodies for the city's medical schools been heated to a high temperature. Only (derived from the fact that victims were by plundering the graves at a Black ceme- the man's head was above ground. Over a sought only at night) applies both to stu- tery. According to historian David C. period of 2 to 3 weeks, Hamilton placed dents of medicine, who supposedly stole Humphrey, southern grave robbers regu- Fed in the pit five or six times and gave cadavers from which to learn about body larly sent bodies of southern Blacks to him various medications to determine processes, and [to] professional thieves, northern medical schools for use as which enabled him best to withstand the who sold stolen bodies-living and anatomy cadavers.'7 heat. Each ordeal ended when Fed fainted dead-to physicians for medical During the early 20th century, and had to be revived. But note that Fed research."'4According to folk belief, these African-American medical leaders pro- was not the only victim in this experiment; sinister characters would kidnap Black tested the abuse of Black people by the its whole purpose was to make it possible people, usually at night and in urban areas, White-dominated medical profession and for masters to force slaves to work still and take them to hospitals to be killed and used their concerns about experimentation longer hours on the hottest ofdays.'2 used in experiments. An 1889 Boston Her- to press for the establishment of Black- In the second experiment, Dr J. Mari- ald article vividly captured the fears that controlled hospitals.'8 Dr Daniel Hale on Sims, the so-called father of modem African Americans in South Carolina had Williams, the founder of Chicago's Provi- gynecology, used three Alabama slave ofnight doctors.