In 1989, Darlene Clark Hine, John A. Hannah Professor of History at Michigan State University, published the path-breaking study of black nurses Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890–1950 (Bloomington: Indiana University Press). The first of two selections that follow provides the beginning of Hine’s consideration of Nurse Eunice Rivers. On 12 June 1993, Hine served as the chair and commentator on the papers of historians Susan Smith and Susan Reverby at the Berkshire Conference of Women Historians on a panel entitled “The Multiple Narratives of Nurse Rivers: The Tuskegee Syphilis ‘Experiment’ and the Problematics of African American Womanhood.” The second selection reflects an editing of Hine’s introduction and comments on this panel (revised versions of both Smith’s and Reverby’s papers appear in this volume).
The racism, poverty, and myriad other forces that influenced black women’s decisions to become nurses all receded once they were actually enrolled in the various training programs. Survival dictated that the student nurses imbibe a sense of the special nature and meaning of their calling. Black nurse supervisors and educators saw to it that their charges measured up to the highest ideals of nursing. If the young novices or probationers failed to be transformed, they were dismissed.
“To make a difference”: this desire undergirded the thoughts and actions of most of the leaders and not a few of the practitioners in the black nursing profession. Perhaps Lillian Harvey, dean of the School of Nursing of Tuskegee Institute from 1944 to 1973, summed up best what it meant to be a nurse. As Harvey explained, one who can make a difference is
the nurse who can look at her patient, for example, and understand what is going on in that patient’s body, anticipate some of the things and let the doctor, the social workers and other persons know what is going on and what might possibly happen and then make herself the facilitator for getting the right people there to take care of whatever it is that is coming up. I feel that a nurse is really the patient’s advocate. You are supposed to be there for the patient on the patient’s side to look after the patient’s best interests.1
Darlene Clark Hine is the John Hannah Professor of History at Michigan State University. Sections originally published in Darlene Clark Hine, Black Women in White. (Bloomington: Indiana University Press, 1989), 133, 134, 154–56, and given as commentary at the Berkshire Conference for the History of Women, 1994. Reprinted by permission of Indiana University Press and Darlene Clark Hine.
… A powerful combination of parental prodding, head-on collisions with racial discrimination, and desire to reduce suffering encouraged not a few black women to consider a nursing career. Eunice Rivers Laurie, born in Early County, Georgia, on November 12, 1899, initially balked when her father suggested that she take up nursing at John A. Andrew Hospital at Tuskegee Institute. Rivers had pleaded, “But Papa, I don’t want to be no nurse. I don’t want folks dying on me.” Undaunted, the father countered, “Well, Eunice, everybody’s ain’t gonna die on you. That’s why should be a nurse. That’s what is being a good nurse, so you could help save the people.” Mollified, Rivers asserted to an interviewer, “Well I decided and he influenced me, but I made up my mind myself.”2
… In many southern black communities, the black nurse, especially the public-health nurse, was the most prominent, if not the first professional, health-care giver to interact with the population. Thus it fell to her to establish the foundation and to define the nature of the professional-client relationship. As one writer put it, “The nurse, therefore, forms the hub around which much of a community’s well-being revolves.”3 Black nurse Willa M. Maddux identified the requirements and characteristics black public-health nurses needed in order to work successfully with, as she phrased it, “the masses of untrained and indifferent people.” Maddux contended, “It is imperative that the nurse be a person with broad sympathies, profound understanding and tact, and possess the requisite professional background.” Writing in 1937, another black nurse from Florida observed similarly, “It is the job of the pioneer nurse to find an acceptable starting point to get the approval of the people that she hopes to serve.”
Commencing in the late 1920s, black nurses began securing positions as public-health nurses with state, local, and federal health departments and agencies. Few of them possessed more than a nursing diploma, but this was more education than the majority of their clientele had received. On January 1, 1923, Eunice Rivers, having recently completed her training at Tuskegee Institute, reported for work, joining the three-member team of Alabama’s Macon County Moveable School. The unit consisted of a teacher, carpenter, and nurse. Nurse Rivers had many wide-ranging responsibilities. She was expected to teach the rural tenant-farmer families the rudiments of home nursing, how to bathe a patient, how to take a temperature, how to give a massage. In summing up in an oral interview her decade of service with mothers and infants, she enumerated her accomplishments. In addition to teaching maternity care to new mothers, she trained
the midwives how to deliver, how to wash their hands, cut their nails and … how to make the pads, how to prepare the bed for the delivery, because at that time most of the women had the babies on the floor.… We had an awful time trying to train the mothers to use the bed instead of the floor. We took paper— and there was no such thing as a draw sheet, a rubber sheet—so we carried old newspapers all the time, on the truck, and clean rags and this kind of thing, trying to teach the people how to do this. If we’d get in a home where we could find somebody who had an old ragged sheet, we’d show them how to make a pad, paper pad, to protect the bed. And also how to bathe the babies, feed them and prepare their meals, their bottles and this kind of thing.4
After nine years, Rivers left the Moveable School to become the nurse for the black men involved with the now-infamous government-run study of venereal disease, the Tuskegee Syphilis Experiment in Macon County, Alabama.
To achieve success as a public-health nurse required well-developed interpersonal-relations skills. None were more adept or possessed of more personality, tact, and determination than Eunice Rivers. Rivers overcame the fears and suspicions of Macon County rural blacks both during her years with the Moveable School and as the nurse with the Tuskegee Syphilis Experiment. Most of her clients evidenced a strong distrust of physicians, refusing to heed their advice or even to seek their services until it was often too late. Rivers lay part of the blame for this reluctance on the heads of the physicians, who quite often simply did not know how to talk to the people. She asserted that she won confidences by first acknowledging that “they’re people as far as I’m concerned. I don’t go there dogging them about keeping the house clean. I go there and visit a while until I know when to make some suggestions. When I go to the house, I accept the house as I find it. I bide my time.” She continued, “Sometimes I don’t do a thing but go there, sit down there and talk.” This tactic proved especially effective and won for her the respect and admiration of not only the black people whom she served but also the black and white physicians with whom she worked.
The white doctors of the experiment marveled at Rivers’ ability to get patients to obey instructions. On occasion, however, she even had to step out of the nurse’s posture of professional subservience and deference to physicians’ authority. In at least one instance she took to task a young white government doctor assigned to the syphilis study. She admonished him, “If anything happens that you can’t get along, that you can’t get it through their heads, just call me. We’ll straighten it out. But don’t holler at them. These are grown men; some of them are old men. Don’t holler at them.” The fact that she interceded and on occasion defended them won their trust. This perhaps explains why many of the black patients involved in the syphilis experiment continued to participate longer than they should have. Rivers was, of course, convinced that the experiment was a good and honorable effort.
Rivers admitted that as a nurse she was rewarded and sustained by the devotion and respect her patients showered upon her. “They depended on me … they would take whatever I said.” Elaborating on her philosophy of the nurse-patient relationship, she added,
After all, the doctor saw the patient and he was gone. And it was up to you to help that patient carry out his orders, do whatever the doctor suggested. The doctor said, you do so and so.… First thing, the patient doesn’t know how to do it. He doesn’t know what his reaction is going to be. He doesn’t want to be stuck, this kind of thing. So the nurse plays an important part there. She’s closer to the patient. Patients would get to the point where if they’re not sure, they’re going to ask you. They get you in the middle.5
Rivers was more than a good country nurse. Her forty-plus years’ involvement in the Tuskegee Syphilis Experiment, in which treatment was deliberately withheld from patients, raises questions concerning relationships between the black nurses and the black community and between black nurses and white healthcare professionals. Indeed, it is fair to say that without her the white “government doctors” would not have been so successful in engaging so many black males in such a detrimental and ethically bankrupt experiment. It was their un-questioning faith in Rivers as someone selflessly looking out for and protecting them that led the men to continue in the experiment for so many unrewarding years. Though they remained fundamentally suspicious of the motives of the “government doctors,” they always tended to do what Rivers told them. According to historian James H. Jones, “More than any other person [Rivers] made them believe they were receiving medical care that was helping them.”6 They were not.
Rivers’ motives for collaborating in this experiment and deliberately manipulating these black men are complex. It is possible that she viewed the study as a way of ensuring for at least some blacks an unparalleled amount of medical attention. Jones offers several compelling explanations for Rivers’ complicity: As a nurse, she had been trained to follow orders, and probably it simply did not occur to her to question a—or, for that matter, any—doctor’s judgment. Moreover, she was incapable of judging the scientific merits of the study. For Rivers, a female in a male-dominated world, deference to male authority figures reinforced her ethical passivity. Finally, and perhaps most significant, Rivers was black, and the physicians who controlled the experiment were white. Years of conditioning and living in the South made it virtually impossible for Rivers to have rebelled against a white, male government doctor, the ultimate authority figure in her world.7 In this case the needs and interests of the black community of Tuskegee were not addressed and protected by the black nurse.
Few issues have aroused the black community’s ire more forcefully than the Tuskegee Syphilis Study. The mere mention of the name sends angry tremors down the backs of even the most resolute black men and women. It has become the powerful symbol of black vulnerability in a white-dominated, capitalistic, patriarchal society. In its deepest sense, “Tuskegee Syphilis” is a potent metaphor for the multiple stratifications along the race, class, sex, and regional grids in twentieth-century America.…
We confront a challenge, however, when attempting to unravel the ironic dilemma of Rivers’ pivotal role in the decades-long continuation of the black men’s futile participation in the ethically bankrupt and useless Tuskegee Syphilis Study. We stand to learn a great deal about the intersections of race, gender, class, and regionality by coming to grips with Tuskegee Syphilis and Nurse Rivers.
The problem is, and I share Susan Smith and Susan Reverby’s unspoken, but omniscient questions: Who was this woman, how representative was she of the African American women of her generation and similar class and professional status? The search for Nurse Rivers is an important quest, and the resolution may affect how black women in general are perceived and studied in the future.
Smith and Reverby take great pains to avoid simplistic dualisms as they seek the real identity of Nurse Rivers. Indeed, Reverby’s cautious disclaimer that she doesn’t “expect to find a truth about Nurse Rivers” is well placed. Moreover, both Smith and Reverby spare us the outmoded “two-ness” construction penned by the historian/activist W. E. B. Du Bois at the turn of the century. Further, Reverby uses to great effect Evelyn Higginbotham’s analysis of the metalanguage of race.8 Both scholars see clearly the ways in which our obsessive emphasis on race has tended to obscure issues of gender and class construction and their intersection.
To my knowledge this is the first panel ever developed by historians to focus attention on Nurse Rivers. This is not to say that others have neglected to remark on her role in Tuskegee Syphilis; it is only to underscore that who she was as a woman, an African American, a nurse, a professional black woman, a southerner, has not received nuanced examination. At the outset I must note the observation that I made in Black Women in White: Racial Conflict and Cooperation in the Nursing Profession that few African American women scholars have evidenced concern with Nurse Eunice Rivers Laurie. I am confident that the future will bring greater interest on their part.9 There is a precedent. Until Nell Painter began working on Sojourner Truth, few African American women had studied one of “the most enigmatic women of the nineteenth century.”10 Painter argues that white feminists, on the other hand, embraced Truth with a passion. She embarked upon an intellectual journey to find out why. Yet, as Reverby effectively demonstrates, Nurse Rivers has not wanted for attention, or suffered from invisibility. On the contrary, she has been the subject of a play and an Emmy award–winning HBO movie, the inspiration of a musical score, and the star of book chapters written by white male historians. She is featured in a traveling “Notable African American Women” exhibit, and was included in the black women’s oral history project by the Schlesinger Library. So, what is the problem?
Could it be that, with few exceptions, black women scholars would like to ignore or dismiss Nurse Rivers for she may well reinforce negative stereotypes that prevail in our society, especially that of the ubiquitous Mammy, who, according to myth and wishful dreaming, was so willing to do the white man’s bidding that she undermined her own community? Does Nurse Rivers hold up a mirror of self-hatred, the ultimate victim and villain combined into one horrible nightmare—a renegade black woman who does not serve her community, or sacrifice herself, who does not transcend her status and oppression, who is compliant and willingly assists in the exploitation of black men? No, better leave such women to the shadows, or to white feminist scholars!
But, then, what are white feminist scholars Susan Smith and Susan Reverby to do? In an essay in the Journal of Women’s History I shared two laments.11 I fretted that too little attention has been devoted to the real working-class status of black women and that the paucity of sustained analysis on the overwhelming poverty of the vast majority of black women has helped to foster erroneous impressions in the larger society of the mythical, heroic, transcendent black woman able to do the impossible, to make a way out of no way. But here is Nurse Rivers, who was neither heroic nor particularly transcendent of everyday racism and sexism. Yet as Smith and Reverby take pains to demonstrate, nor was she a villainous devil or mean-spirited witch. Dichotomous representations will always obscure black women and need to be avoided.
My second lament was an explicit call for more black women historians to write histories of white women, and an implicit challenge for white women historians to do likewise. My reasoning was that only through crossover history could we become more knowledgeable of each other and begin to break down intellectual and professional boundaries, to refine and to take even more seriously our methodologies of intersectional analysis.
Susan Smith and Susan Reverby have picked up the challenge, and they have wrought well. Reverby is very stand up about her quest: “Finding Eunice Rivers requires us to examine the use of race as a metalanguage to understand African American women and to analyze the narrow representations that have haunted their lives.”
At the outset Susan Smith poses a series of critical questions. “What can this case study tell us about class difference among African Americans?” She uses her previous research on the black health movement in the early twentieth century to place Tuskegee Syphilis within the larger southern context of black disease and poverty, and racial exploitation. Her second critical question concerns Nurse Rivers and her role as a complex historical subject, not just as a victim or evil nurse. She asks, “What does it mean, then, to talk about the agency of Black women within racism and sexist social structures?” Again, Smith frames her investigation of this question by placing Rivers within the broader context of twentieth-century public-health work. She does a fine job of describing this work and the interpersonal relations skill that Rivers brought to it. She also captures well Rivers’ desire to advance and to find secure regularized employment. Smith elaborates on how Rivers constructed a livelihood by knitting together several part-time jobs. Smith links Tuskegee Syphilis with white racism, and illuminates the differences between this study and the Oslo study that traced untreated syphilis in Norway. The difference needs underscoring. “The Oslo study was a retrospective study examining previous case records of white people whose syphilis went untreated, unlike the Tuskegee Study which was designed to deliberately withhold available treatment from Black people.”
Smith makes two additional points that are important correctives to conventional misinformation: the study was not a government secret, kept hidden from health professionals, and a number of black health professionals engaged in the project for expedient reasons. The experiment on poor black men simply was not viewed as a problem by middle-class, professional black men. Class privilege blinded them to the study’s immorality. I am curious as to whether the NAACP knew of the study, or other black protest groups. Was this study deemed less important because it concerned southern black men? Without such investigation we are left concluding that blacks were as culpable as were the whites who initiated the study. Obvious reliance on, and need of, government resources for other health projects led some black professionals to turn a blind eye to Tuskegee Syphilis. Is this a rationalization or explanation for their action?
I do question whether Rivers had the authority, as Smith suggests, to implement “the policy of the Public Health Service to prohibit the subjects of the study from receiving treatments for syphilis from anyone else, even after World War II when penicillin became available.” There is a critical distinction between knowing about the experiment or study and failing to denounce it for purely expedient reasons, and actively directing or setting policy that in effect signed the death warrants of 100 men after a proven cure was available. In other words, I suspect there were limits to Rivers’ agency. One reading of Smith’s portrait evokes a Rivers who was knowledgeable, assertive, and hungry for employment and prestige, a woman who actually believed that the experiment served the best interest of the men fortunate enough to be involved. The problem is that if she is neither victim nor villain, as Smith has constructed her, are we now left to imagine that she was in charge? Here Smith goes out on a tenuous limb and seems in danger of minimizing how much race, sex, and class oppression operate and intersect to limit Rivers’, and by extension any black woman’s, agency. I would caution against taking Rivers’ assertions of her innocence—“I know I didn’t mislead anyone”—as the final word. Historians know that people deceive themselves all the time. Smith has given us much to think about in this intelligent presentation.
Reverby has written a multilayered essay that is distinguished by its use of “multiple narratives” of Nurse Rivers. Reverby’s women’s studies and historical approach begs examination of a much broader universe of sources and documents reflecting divergent perspectives on the significance of Rivers to the Tuskegee Syphilis Study. Accordingly, she provides an insightful analysis of the play by Dr. David Feldshuh, Miss Evers’ Boys, which we saw together in Atlanta. She uncovered a new oral interview of Nurse Rivers, and has read all of the secondary historical works, and finally, she listened to original musical compositions. Thus she has an impressive command of what has been written and imagined about Nurse Rivers.
… Reverby’s guarded reading of Rivers’ own accounts of her story raised a number of questions. I applaud Reverby’s delineation of the three substantial themes found in Rivers’ own narrative. It is clear that she viewed herself as a competent caring professional whose work, including “ ‘treating’ the syphilitic sharecroppers,” helped to uplift the race. But try as she might, and she is to be commended for her intelligent effort, Reverby is doomed to remain frustrated in her quest to find the whole Rivers, I suspect, not only because of the black nurse’s use of multiple voices and strategic silences, but also because Rivers dissembles with consummate skill.12 While Rivers confuses caring with treatment, she cannot escape or explain away the fact that she denied penicillin to the men. This remains the ethical or moral horns of the dilemma upon which rests her significance as a historical figure. I suspect that she knew this.
And in one poignant passage, Reverby reveals that she is also knowing. “We are fascinated by her seeming innocence and her culpability. Despite our effort not to, I suspect we, and in this case me as a white woman and a nursing historian, still want her to have more power to serve as the talisman to absorb our moral uncertainties.”
Reverby urges that we read Rivers’ narrative as that of a “race woman” in order to understand her “gendered class attitudes.” The works of two black women historians, Elsa Barkley Brown and Sharon Harley, may further illuminate this discussion.13 Brown defines womanism as a consciousness that incorporates racial, cultural, sexual, national, economic, and political considerations into agency. To be a race woman, or a womanist, which entailed being both simultaneously, was a big order. It requires holding together many constituencies and multiple purposes all at once. The key question is this: Was Eunice Rivers a true race woman of the stripe of Maggie Lena Walker or Nannie Helen Burroughs?
Sharon Harley’s essays on the black middle class help us to grasp more firmly the slippery concept of class. Harley distinguishes between the black upper-middle-class elite and the black middle class, whose “incomes were often too low, job security too elusive, and racial discrimination too widespread for most middle-class Black women to boast of being anything other than servants of their people.”
Finally, I would like to reiterate one of Reverby’s key points:
Her silences and inability to find the words, or the permission to utter them, to even explain her situation with James [a black physician involved in the study] suggest how powerful the pressures were to downplay the ways racism shaped the role of the black professional and Tuskegee Institute in the study. The overwhelming racism that motivated and perpetuated the study almost made it impossible to speak of the complexity of class and gender within the black community and made it almost impossible for her to find the words at all to explain what she thought had happened.
While Rivers may not have found her words to explain what happened, it is the task, or curse, of the historian to never stop trying. Whatever it takes, we must continue our pursuit of Nurse Rivers and her elusive truths.
1. Interview with Lillian Harvey, 8 January 1976, conducted by Patricia Sloan. Original transcript is in the M. Elizabeth Carnegie Nursing History Archive, Hampton University School of Nursing, Hampton, Va. For a critique of the idealized images and unrealistic expectations of nurses, see Janet Muff, “Of Images and Ideals: A Look at Socialization and Sexism in Nursing,” in Images of Nurses: Perspectives from History, Art, and Literature, edited by Anne Hudson Jones (Philadelphia: University of Pennsylvania Press, 1988), 197–200.
2. Interview with Eunice Rivers [Laurie], 10 October 1977, Schlesinger Library Black Women’s Oral History Project, Radcliffe College, Cambridge, Mass.
3. Gerald A. Spencer, Medical Symphony: A Study of the Contributions of the Negro to Medical Progress in New York (New York: Arlain Printing Co., 1947), 107.
4. Interview with Eunice Rivers [Laurie].
5. Ibid.
6. Ibid.; James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1981), 160.
7. Jones, Bad Blood, 164–67.
8. Evelyn Brooks Higginbotham, “African American Women’s History and the Metalanguage of Race,” Signs 17 (Winter 1992): 251–74.
9. At the time this article was written, Evelynn M. Hammonds’ article on Nurse Rivers was not yet available. However, it does appear in this volume.
10. Nell Irvin Painter, Sojourner Truth: A Life, a Symbol (New York: W. W. Norton, 1996).
11. Darlene Clark Hine, “Black Women’s History, White Women’s History: The Juncture of Race and Class,” in Journal of Women’s History 4 (Fall 1992): 125–33.
12. Darlene Clark Hine, “Rape and the Inner Lives of Southern Black Women: Thoughts on the Culture of Dissemblance,” in Southern Women: Histories and Identities, edited by Virginia Bernhard et al. (Columbia: University of Missouri Press, 1992), 177–89. In the same volume, see Cheryl Thurber, “The Development of the Mammy Image and Mythology,” pp. 87–108. By “dissemblance,” I mean the behavior and attitudes of black women that created the appearance of openness and disclosure but actually shielded the truth of their inner lives and selves from their oppressors.
13. Sharon Harley, “The Middle Class,” in Black Women in America: An Historical Encyclopedia, edited by Darlene Clark Hine, Elsa Barkley Brown, and Rosalyn Terborg-Penn (New York: Carlson Publishing Co., 1993), 786–89; Elsa Barkley Brown, “Womanist Consciousness: Maggie Lena Walker and the Independent Order of Saint Luke,” Signs 14 (Spring 1989): 610–33.