Tuskeegee Study

Tuskegee Study of Untreated Syphilis in the Negro Male

"From 1932 up until 1972, the United States Government engaged in a scientific study in which a group of approximately 400 African-American men with syphilis were analyzed but left untreated"(http://www1.umn.edu.scitech/tuskegee.htm). The Tuskegee Study of Untreated Syphilis was lead by the United States Public Health Service (PHS) that took advantage of uneducated, poor, African-American farmers from Macon County, Alabama. "The experiment origins actually began with good intentions. In 1929, prior to the inception of the study, blood tests for African-Americans were funded by The Rosenwald Foundation for Black Community Development in the South. These blood tests were intended to locate the presence of syphilis, after which treatment could begin" (http://www1.umn.edu.scitech/tuskegee.htm). After discovering that treating all the infected men would be monetarily unfeasible, Dr. Taliaferro Clark, director of the PHS, proposed a more critical suggestion. He proposed to study the effects of untreated syphilis (in its late stages) in the black male, which was initiated at the Tuskegee Institute in Macon County, Alabama. After Dr. Clark retired in June of 1933, Dr. Raymond Vonderlehr succeeded him as the director of the Division of Venereal Diseases.

The true nature of the experiment had to be kept from the subjects to ensure their cooperation. The study was meant to discover how syphilis affected blacks as opposed to whites--the theory being that whites experienced more neurological complications from syphilis, whereas blacks were more susceptible to cardiovascular damage. How this knowledge would have changed clinical treatment of syphilis is uncertain (http://infoplease.com/spot/bhmtuskegee1.html). The government doctors associated with the study refused to use the term syphilis. Instead, doctors misled those that tested positive for the venereal disease by informing them that they simply had bad blood. Even when penicillin became available in 1947, the men were denied access to treatment because it would intervene with the results of the study. In fact, local physicians, draft boards and PHS venereal disease programs were given a list of "subjects." The only treatment the men received was aspirin and iron supplements. In view of the fact that none of the men had ever had little or no healthcare, they deemed this to be a very effective means in curing their bad blood. In exchange for taking part in the study, the men received free medical exams, free hot meals, a certificate signed by the surgeon general, and a $50 burial stipend. The date for this experiment was to be collected from autopsies of the men. Although originally projected to last 6 months, the study actually went on for 40 years. Regulations for using human beings in medical experiments are supposed to be strict, requiring patients to have a full knowledge and clear understanding of the health risks and benefits.

"Syphilis is a highly contagious disease caused by the spirochete Treponema pallidum. This disease may be acquired or congenital. In acquired syphilis, T. Pallidum enters the body through skin mucous membranes, usually during sexual contact. Congenital Syphilis (CS) is transmitted to the fetus from the infected mother when the spirochete penetrates the placenta. Syphilis is a systemic disease, involving tissues throughout the body. After initial penetration, the spirochetes multiply rapidly. First they enter the lymph capillaries where they are transported to the nearest lymph gland. There they multiply and are released into the blood stream. Within days the spirochetes invade every part of the body. (http://www.dreamscape.com/morgana/adrastea.htm). A multiorgan infection, CS may result in a neurologic or musculoskeletal handicap or death in the fetus when not properly treated. Trends in CS rates in women of childbearing age follow by approximately 1 year the rates of primary and secondary syphilis. Racial/ethnic minorities continue to be affected disproportionally by CS. No biologic association exists between race and the risk for delivering an infant with CS; race serves as a marker for other factors, such as poverty and access to health care, in communities with high syphilis rates (5-7). Individual factors, such as illicit drug use and the wantedness of pregnancy, also influence the chances of a mother delivering an infant with CS.

(http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4834a3.htm).

In acquired syphilis, the organism rapidly penetrates intact mucous membranes or microscopic dermal abrasions and, within a few hours, enters the lymphatics and blood to produce systemic infection. The central nervous system is invaded early in the infection; during the secondary stage, examinations demonstrate that more than 30% of patients have abnormal findings in the cerebrospinal fluid (CSF). During the first 5-10 years after infection, the disease principally involves the meninges and blood vessels, resulting in meningovascular neurosyphilis. Later, the parenchyma of the brain and spinal cord are damaged, resulting in parenchymatous neurosyphilis. Three stages mark the progression of the disease: primary, secondary and tertiary.

The primary stage commences 10-60 days after the infection. Lesions usually appear at the point of contact, which is typically the genitals. After which, a painless, somewhat raised, round ulcer appears. The chancre may be so small, it can go undetected. Leading into the secondary stage, this chancre will heal without any treatment within 30-60 days hence, leaving a scar that can remain for months.

The secondary stage lasts from approximately 6 weeks to 6 months. During this time, a rash similar to measles or chicken pox appears on the skin. Fever, indigestion and headaches may accompany the rash. Bones and joints may be painful and cardiac palpitations may also develop. "In some cases, highly infectious, spirochete-laden ulcers may appear in mouth. Scalp hair may drop out