Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (review)

“Bad blood” usually evokes the idea of hostile relations between groups or individuals, an emotional spectrum that stretches from lingering distrust to deep-seated enmity. Yet as Susan M. Reverby’s masterful Examining Tuskegee: The Infamous Syphilis Study and Its Legacy explains, the catchphrase took on other nuances in the context of American public health policy during the Jim Crow era. As Reverby illustrates, having “bad blood” was a euphemism for carrying the venereal disease syphilis, also known throughout its long global presence as “the pox,” the “bad disease,” and “lues venereal,” its Latin name (23). Yet the equation of epithet and epidemic was not always clear and immediate, especially to some of the approximately 600 African American men (400 of whom had the disease and 200 controls who did not), all participants in the forty-year Tuskegee Syphilis Study (1932–72). The U. S. ublic Health Service (PHS) commenced its research in Tuskegee, the Macon County, Alabama city made famous by the legacy of Booker T. Washington, accommodationist educator and author of the well-known autobiography Up from Slavery (1901). The study sought to examine the effects of nontreatment on late-stage, latent (thus, noncontagious) syphilis, but did so without the ethical transparency expected of today’s medical research community. Tuskegee’s rural male subjects were not aware that treatment was being deliberately withheld. Enticed by physicians seeking what would essentially be informative corpses, they were promised medications (a semblance of treatment), free meals, transportation to and from testing sites, burial insurance or assistance, and the satisfaction of serving in an important initiative aimed at the greater good (79). This was a carefully engineered duping that led to misplaced trust, possible early death and disability, and the genesis of a complex and damaging narrative of state abuse that still grips the nation’s ethical imagination.

Reverby’s text has three self-contained yet complementary sections with alliterative sub-headings. Each explains the central preoccupation of the historian as an excavator of competing versions of truths. Hearing testimony, testifying, and traveling are all acts that transcend any particular academic specialty, so the scope of the text is established early on as broadly interdisciplinary. Part one (“Testimony”) offers a detailed summary and analysis of the study’s history, beginning with an overview of syphilis’ cultural significance and the cruces of morality, medicine, and race as they pertained to the segregation era’s public health apparatus. Part two (“Testifying”) focuses on the notion of voice—who was silenced, who spoke up, whose stories were heard, and whose deserve more concentrated regard—while offering short character sketches of black health care personnel integral to the study. These included Dr. Eugene H. Dibble of Tuskegee Institute and public health nurse Eunice Verdell Rivers Laurie, most commonly known as Nurse Rivers. Part three (“Traveling”) is a meandering foray into how postwar American society and its imaginative arbiters channeled their moral outrage into art. Reverby explains how the creative products, among them David Feldshuh’s play Miss Evers’ Boys, and its subsequent movie version, have not always been historically accurate; despite this, they serve as emotionally charged catalysts for a more vigilant and historically informed public. Also included in this section are supporting chapters on Henry W. Foster Jr.’s failed bid for Surgeon General and a dissection of the official apology by the Clinton administration. After a personally inflected epilogue, the author includes extensive appendices, among them a compendium of the major figures’ names as well as a list of study participants. This latter information was released publicly for the first time in 1997. There are also tables and charts on probable outcomes for untreated latent syphilis, the dates of participant recruitment, the men’s relative ages at the start of the study, and autopsy statistics. While it appears that there is no dearth of information on the subject, Examining Tuskegee compels us to think again.

One abiding feature of Reverby’s historical assessment is...