A Timeline
The Rosenwald Fund votes to spend up to $50,000 from January through December 1930 for syphilis-control demonstration programs. The Public Health Service (PHS) recommends six locations for the program: Macon County, Alabama; Scott County, Mississippi; Tipton County, Tennessee; Glynn County, Georgia; Pitt County, North Carolina; Albemarle County, Virginia.
The program begins in Macon County, Alabama, and the five other recommended sites in the South.
Dr. H. L. Harris Jr. makes a site visit for the Rosenwald Fund to Macon County, Ala.
Harris visits the Macon County site again, and he recommends that the project be discontinued (it is) and a comprehensive health plan be implemented (it is not).
The PHS proposes to study untreated syphilis in Macon County, since the prevalence of syphilis is 35 percent, the highest of all demonstration programs. Tuskegee Institute officials and the local health department agree to the study. Nurse Eunice Rivers is appointed to the study as a liaison to the men.
The PHS study of untreated syphilis begins in and around Macon County. The projected length of the study is 6–8 months and includes black men at least 25 years old who have had positive Wassermans (confirmed by a second test), who have had syphilis for at least five years (determined by onset of chancres), and who have not been treated. Subjects are then administered less than the recommended amount of therapy.
Susan E. Bell is professor of sociology at Bowdoin College.
Printed by permission of Susan E. Bell.
The study’s participants are subjected to spinal taps to diagnose neural syphilis.
Dr. Taliaferro Clark retires from the PHS; Dr. Raymond A. Vonderlehr succeeds him and continues the study. Vonderlehr hospitalizes terminally ill subjects at Tuskegee Institute Hospital and adds autopsies to the study’s protocol. The only further treatment the men receive from the PHS is aspirin, protiodide, iron, and placebos. Over the next four decades the head of the Division of Venereal Disease (VD) is usually recruited from a man who has worked on the Tuskegee Syphilis Study.
Vonderlehr begins selecting a group of men as subjects and controls for the study.
The Milbank Memorial Fund gives the first annual award of $500 to the PHS to use for the burial stipends for families of subjects consenting to autopsies ($50/subject).
The first report of the study is published: R. A. Vonderlehr et al., “Untreated Syphilis in the Male Negro: A Comparative Study of Treated and Untreated Cases,” Venereal Disease Information 17 (1936): 260–65.
The PHS begins administering penicillin to people with syphilis in several U.S. treatment centers.
The second and third reports of the study are published: John R. Heller et al., “Untreated Syphilis in the Male Negro: Mortality during Twelve Years of Observation,” Venereal Disease Information 27 (1946): 34–38; A. V. Deibert et al., “Untreated Syphilis in the Male Negro: III. Evidence of Cardiovascular Abnormalities and Other Forms of Morbidity,” Journal of Venereal Disease Information 27 (1946): 301–14.
The fourth report on the study is published: Pasquale J. Pesare et al., “Untreated Syphilis in the Male Negro: Observation of Abnormalities over Sixteen Years,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 34 (1950): 201–13.
The PHS reviews the Tuskegee Study procedures and recommends changes.
The study’s files are reorganized, autopsy reports are transferred to punch cards, and a single set of diagnostic standards for syphilis and syphilitic heart disease are adopted.
A study of aging is added to the original syphilis study.
The fifth report on the study is published: Eunice Rivers et al., “Twenty Years of Followup Experience in a Long-Range Medical Study,” Public Health Reports 68 (1953): 391–95.
The sixth and seventh reports on the study are published: J. K. Shafer et al., “Untreated Syphilis in the Male Negro: A Prospective Study of the Effect on Life Expectancy,” Public Health Reports 69 (1954): 691–97; Sidney Olansky et al., “Environmental Factors in the Tuskegee Study of Untreated Syphilis,” Public Health Reports 69 (1954): 691–98.
The eighth and ninth reports on the study are published: Jesse J. Peters et al., “Untreated Syphilis in the Male Negro: Pathologic Findings in Syphilitic and Nonsyphilitic Patients,” Journal of Chronic Diseases 1 (1955): 127–48; Stanley H. Schuman et al., “Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study,” Journal of Chronic Diseases 2 (1955): 543–58.
The tenth and eleventh reports on the study are published: Sidney Olansky et al., “Untreated Syphilis in the Male Negro: X. Twenty Years of Clinical Observation of Untreated Syphilitic and Presumably Nonsyphilitic Groups,” Journal of Chronic Diseases 4 (1956): 177–85, and “Untreated Syphilis in the Male Negro: Twenty-two Years of Serological Observation in a Selected Syphilis Study Group,” A.M.A. Archives of Dermatology 73 (1956): 519–22.
The PHS distributes certificates of appreciation and cash payments of $25 to the subjects.
Nurse Rivers (Laurie) wins the Third Annual Oveta Culp Hobby Award, the highest commendation the United States Department of Health, Education, and Welfare (HEW) can bestow on an employee.
The PHS begins a regular distribution of small cash payments of $1–2 per subject to induce cooperation.
The twelfth report on the study is published: Donald H. Rockwell et al., “The Tuskegee Study of Untreated Syphilis: The Thirtieth Year of Observation,” Archives of Internal Medicine 114 (1961): 792–98.
Pure Food and Drug Act Amendments order doctors to inform patients when they are being given drugs experimentally.
World Health Organization issues the Declaration of Helsinki, which contains stringent provisions regarding informed consent.
For the first time, a member of the medical profession objects to the study in a letter to the PHS.
The surgeon general issues Policy and Procedure Order No. 129 establishing guidelines for, among other things, peer review for publicly funded research (revised in 1969 and 1971).
Peter Buxton, a PHS venereal disease interviewer and investigator, expresses grave moral concerns about the study to the Centers for Disease Control (CDC).
The Alabama State Board of Health and the Macon County Medical Society support continuation of the study. The Tuskegee Institute again becomes actively involved with the study, and a new nurse is appointed in addition to Nurse Rivers (Laurie).
The CDC convenes a panel of physicians and scientists to investigate the study. The panel recommends continuation. One panelist objects to the decision.
The assistant chief of the VD Branch of the PHS says the study is incongruous with the goals of PHS and is bad science, but he opposes ending it.
Buxton tells an Associated Press reporter about the study.
The Associated Press sends the story about the study to major newspapers.
After a public outcry, the HEW appoints an ad hoc panel to review the study.
The thirteenth and last report on the study is published: Joseph G. Caldwell, “Aortic Regurgitation in the Tuskegee Study of Untreated Syphilis,” Journal of Chronic Diseases 26 (1973): 187–94.
Senator Edward Kennedy holds hearings on human experimentation before the Subcommittee on Health of the Committee of Labor and Public Welfare, U.S. Senate.
New HEW guidelines including treatment and compensation are established regarding research projects involving human subjects.
The HEW halts the study by authorizing treatment.
The CDC offers to find subjects, treat them, and pay for their medical care, but does not offer the study’s participants compensation.
A $1.8 billion class-action lawsuit is filed against the United States, HEW, PHS, CDC, the State of Alabama, the State Board of Health of Alabama, the Milbank Fund, and some individuals connected with the study.
A settlement is reached and the government agrees to pay approximately $10 million. Each living syphilis subject receives $37,500, the heirs of each deceased subject with syphilis are awarded $15,000, each living control is granted $16,000, and each deceased control is awarded $5,000.
The U.S. government extends treatment to the subjects’ wives and children who have contracted syphilis.
The last payments are made to survivors, controls, and their heirs. Medical care continues.
President Bill Clinton and Vice President Al Gore offer a formal apology in a White House ceremony.