Perspectives

Reaching for Harrison’s and the Tuskegee Study of Untreated Syphilis

Authors: Robert M. White, MD

Abstract

The Tuskegee Study of Untreated Syphilis (TSUS) was the 1932–1972 study of approximately 600 Black men, 400 with active syphilis and 200 presumably without syphilis, in rural Macon County, Alabama. The study evolved from a one-evaluation datapoint to a longitudinal study with detailed case histories and autopsies. These parameters assessed the presence or absence of syphilis-related damage.1 It ended in scandal in 1972, as reported in the media.2
Posted in: Infectious Disease136

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References

1. Schuman SH, Olansky S, Rivers E, et al. Untreated syphilis in the male Negro. Background and current status of patients in the Tuskegee study. J Chron Dis 1955;2:543–558.
 
2. Heller J. Syphilis victims in U.S. study went untreated for 40 years. https:// timesmachine.nytimes.com/timesmachine/1972/07/26/80798097.html? pageNumber=1. Published July 26, 1972. Accessed October 1, 2021.
 
3. Russell T. Racism in care leads to health disparities, doctors and other experts say as they push for change. https://www.washingtonpost.com/health/racismin-care-leads-to-health-disparities-doctors-and-other-experts-say-as-theypush-for-change/2020/07/10/a1a1e40a-bb9e-11ea-80b9-40ece9a701dc_story. html. Published July 11, 2020. Accessed October 1, 2021.
 
4. Frakt A. Race and medicine: the harm that comes from mistrust. https:// www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comesfrom-racism.html. Published January 13, 2020. Accessed October 1, 2021.
 
5. Holmes KK. Syphilis. Natural course of untreated syphilis. In: Wintrobe MM, Thorn GW, Adams RD, et al, eds. Harrison's Principles of Internal Medicine, 7th ed. New York: McGraw-Hill; 1974:877–878.
 
6. Lukehart SA. Syphilis. Natural course and pathogenesis of untreated syphilis. In: Kasper DL, Fauci AS, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine, 19th ed. New York: McGraw-Hill Education; 2015:1134.
 
7. Lukehart SA. Syphilis. Natural course and pathogenesis of untreated syphilis. In: Jameson JL, Fauci AS, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine, 20th ed. New York: McGraw-Hill Education; 2018: 1280–1281.
 
8. Alsan M, Wanamaker M. Tuskegee and the health of black men. Q J Econ 2018;133:407–455. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258045/ pdf/nihms952533.pdf. Accessed October 1, 2021.
 
9. Jones JH. Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press; 1993:91, 93.
 
10. Geiger HJ. An experiment with lives. https://timesmachine.nytimes.com/ timesmachine/1981/06/21/166006.html?pageNumber=67. Published June 21, 1981. Accessed October 1, 2021.
 
11. Palmer CA. Public Health in the South. Reviewed Works: Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones and The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South by John Ettling. Rev Am Hist 1982;10:229–233. https://www.jstor.org/stable/ 2702334. Accessed October 1, 2021.
 
12. Reverby SM, ed. Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study. Chapel Hill, NC: University of North Carolina Press; 2000: xii, 348, 410, 418, 559.
 
13. Rivers E, Schuman SH, Simpson L, et al. Twenty years of follow-up experience in a long-range medical study. Publ Health Rep 1953;68:391–395. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC2024012/pdf/pubhealthreporig00184-0037. pdf. Accessed October 1, 2021.
 
14. Rosahn PD. Studies in syphilis. VII. The end results of untreated syphilis. J Vener Dis Inf 1946;27:293–301. https://babel.hathitrust.org/cgi/pt?id= inu.30000100134133&view=1up&seq=327&q1=paul%20d%20%20.% 20rosahn. Accessed October 1, 2021.
 
15. Gjestland T. The Oslo Study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon re-study of the Boeck-Bruusgaard material. Acta Derm Venereol Suppl (Stockh) 1955; 35(suppl 34):3–368.
 
16. Moore JE. The natural history of chronic illness. J Chron Dis 1955;2:335–337.
 
17. Termini BA, Music SI. The natural history of syphilis: a review. South Med J 1972;65:241–245.
 
18. Myers JA. The natural history of tuberculosis in the human body. Forty-five years of observation. JAMA 1965;194:1086–1092.
 
19. Eng J, Wereide KA. TPI test in untreated syphilis. A serological re-examination of 50 patients belonging to the “the Oslo Study of Untreated Syphilis”. Br J Vener Dis 1962;38:223–229, https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1047514/pdf/brjvendis00122-0054.pdf. Accessed October 1, 2021.
 
20. Jones JH, King NMP. Bad Blood thirty years later: a Q&A with James H. Jones. J Law Med Ethics 2012;40(Winter 4):867–872.
 
21. Cave VG. New trends in syphilology. J Natl Med Assoc 1969;61:158–163, 204. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611704/pdf/jnma00516-0058. pdf. Accessed October 1, 2021.
 
22. Editorial: “Dr. Foster and the syphilis study.” The Washington Post (March 1, 1995). In: Hearings of the Committee on Labor and Human Resources, United States Senate, One Hundred Fourth Congress, First Session, on Henry W. Foster, Jr., of Tennessee, to Be Medical Director in the Regular Corps of the Public Health Service, and to be Surgeon General of the Public Health Service, May 2 and 3, 1995. Washington, DC: US Government Printing Office; 1995:217–218. https://babel.hathitrust.org/cgi/pt?id=pst. 000024373074&view=1up&seq=221&skin=2021&q1=w%20%20ashington% 20post. Accessed October 1, 2021.
 
23. Clinton WJ. Remarks by the President in apology for study done in Tuskegee. The White House. Office of the Press Secretary. https://clintonwhitehouse4. archives.gov/textonly/New/Remarks/Fri/19970516-898.html. Published May 16, 1997. Accessed October 1, 2021.
 
24. Lukehart SA, Holmes KK. Syphilis. Natural course and pathogenesis of untreated syphilis. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGrawHill Companies; 1998:1025.
 
25. Thomas SB, Quinn SC. The Tuskegee Syphilis Study, 1932 to 1972: implications for HIVeducation and AIDS risk education programs in the black community. Am J Public Health 1991;81:1498–1504. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1405662/pdf/amjph00211-0136.pdf. Accessed October 1, 2021.
 
26. Rockwell DH, Yobs AR, Moore MB Jr. The Tuskegee study of untreated syphilis. The 30th year of observation. Arch Intern Med 1964;114:792–798.