On May 16th, 1997, President Bill Clinton addressed the nation from The East Room in the White House to issue a formal apology on behalf of the government to the American people.[1] A complete quarter century after the public discovery of the Tuskegee Syphilis Study, the President finally had finally come forward with a belated apology. Bill Clinton’s speech began with a birthday wish to Mr. Shaw, one of the eight remaining survivors of the Tuskegee Syphilis Study at the time.[2] He continued to speak, apologizing for the despicable study and assuring the public that steps were being taken to prevent another occurrence. President Clinton summarized the atrocity aptly when he said, “Men who were poor and African American, without resources and with few alternatives, they believed they had found hope when they were offered free medical care by the United States Public Health Service. They were betrayed.”[3] The apology was a crucial step towards healing a devastated community, but words alone cannot make amends for the deep cutting legacy of the Tuskegee Study.

Twenty-five years before Clinton’s speech, on July 26, 1972, an article written by Jean Heller on the front page of the New York Times read, “For 40 years the United States Public Health Service has conducted a study in which human beings with syphilis, who were induced to serve as guinea pigs, have gone without medical treatment for the disease and a few have died of its late effects, even though an effective therapy, was eventually discovered.”[4] And just like that, the cover was blown off the Tuskegee Syphilis Study. The 40-year-long study that condemned 400 black men from Macon County, Alabama to a prolonged death from syphilis was finally over. Fingers began to point in all directions as soon as the news hit national headlines. The conductors of the study had idly observed and withheld available treatments as these latent syphilitics deteriorated in health. While much attention was paid to Eunice Rivers, an African-American nurse, who played a pivotal role in the orchestration of the study and became the familiar scapegoat, the study began under the direction Dr. Taliaferro Clark, a senior Public Health Service officer, and continued under the control of Dr. Raymond H. Vonderlehr.[5] The end of the study left behind many questions. What were the ethical considerations? What motivated Ms. Rivers, an African-American woman, to participate in the study? And perhaps the most important question; who is to blame for the transgressions?

Syphilis has been present in humans for hundreds or years. It is a sexually transmitted disease caused by the Treponema pallidum bacterium. There are many theories about the affliction’s origins, with some scientists hypothesizing that the venereal disease originated from south-west Asia around 3000 BC, and others supporting the idea that Columbus and his crew returned to Europe from the New World bringing syphilis along with them.[6] However, treatment for the disease remained very crude, dangerous, and ineffective due to a limited scientific understanding. In the 16th century, physicians applied a heavy metal mercury paste on the backs of patients.[7] They later used the heavy metal bismuth, but both treatments were quite toxic and only ameliorated symptoms without attacking the disease itself.

The first real scientific breakthrough for the treatment of syphilis came from German scientist Paul Ehrlich (1854-1915), who received a Nobel Prize in Physiology and Medicine in 1908 for his discovery of arsphenamine (Salvarsan).[8] It was later discovered that Salvarsan treatment had caused several deaths in syphilitic patients. In 1912, Ehrlich developed a less toxic form, neoarsphenamine (Neosalvarsan), which he called “the magical bullet”.[9] However, this treatment required an intramuscular injection with up to 40 dosages over the course of a year that cost a dollar per visit. It was far from the magic bullet he claimed it was. The treatment proved to be too expensive and time consuming for most people.

Efforts to better understand the progress of syphilis and to develop better treatment were widely encouraged by the US Public Health Service. In 1929, the philanthropical Julius Rosenwald Foundation took initiative to conduct a survey, screening for syphilis in black communities. The Rosenwald Foundation focused its efforts on bettering the state of black people in America. The foundation hoped to provide mass treatment for the syphilitic patients. The US Public Health Service appointed senior officer Dr. Taliaferro Clark to be the US Public Health Service advisor to the study. The Rosenwald Foundation chose to study inhabitants of Macon County, Alabama; Tipton County, Tennessee; Scott County Mississippi; Glynn County, Georgia; Pitt County, North Carolina; and Albemarle County, Virginia.[10] These six counties were evaluated by the Public Health Service to represent a wide sample of conditions under which African Americans lived in the rural south, and all six counties exhibited syphilis rates that were notably high. Of the six counties surveyed, Macon County proved to unveil the most interesting story.

Of the 3,684 African Americans tested in Macon County from 1929 to 1930, the study discovered 1,468 cases of syphilis.[11] Dr. Clark, the US Public Health Service advisor to the study, also noted, “of the total 1,400 cases admitted to treatment but 33 of them had ever had any previous treatment, and that they averaged only 4.5 doses of neoarsphenamine to the individual.”[12] Only upper middle class people could afford the complete treatment. Of the 27,000 people in Macon County, over half lived far below the poverty line.[13] Their average median income was a dollar a day. However most of the black sharecroppers never saw any of their earnings; the money went straight to the landowners.[14] Charles Johnson (1893-1956), an American sociologist, and the first black president of Fisk University, recorded the sentiments of a black sharecropper from Macon County who was a part of the Rosenwald study; “Ain’t make nothin’, don’ speck nothin’ til’ I die.”[15]

In his proposals, Dr. Clark failed to mention that the African American men would not be informed of their participation in the study, nor of their ailments.

The Rosenwald Foundation began offering treatments to some of the patients, but the process was expensive and slow. Further, the high rates of syphilis unveiled by the study would have severely damaged the image of Black Americans if the results were published nationwide. The Rosenwald Foundation aimed to help black people, and many trustees began to reevaluate their support of the study.[16] At the same time, in 1930, effects of the Great Depression also took a heavy toll on funds for philanthropy. The Rosenwald Fund withdrew from the study in 1930, and budget cuts for public health meant that subsidized treatment for all the syphilitics was near impossible. The US Public Health Service budget dropped rapidly from one million dollars at the start of the study in 1929 to a measly sixty-thousand five years into the Great Depression.[17] As the cash flow trickled to a stop, the treatments virtually stopped in all parts of the study and the findings were ignored.

Macon County’s high rate of syphilis in combination with the extreme poverty and lack of mobility in the population presented a tantalizing opportunity to Dr. Clark. In a letter to Dr. J. N. Baker, the State Health Officer of Alabama, Dr. Clark tentatively proposed a new study in Tuskegee; “It seems to me that this situation in a very heavily infected population group affords an unparalleled opportunity of studying the effect of untreated syphilis on the human economy.”[18] In his proposals, Dr. Clark failed to mention that the African American men would not be informed of their participation in the study, nor of their ailments. He also neglected to tell Baker that these people did not have the economic means to move away from the area or afford treatment for syphilis. In a few short months, the state gave Dr. Clark the green light to conduct a vile experiment that would turn out to be one of the United States’ worst ethical oversights.

In 1932, Clark appointed Dr. Raymond Vonderlehr to be the on-site director of his study.[19] Dr. Vonderlehr began selecting the men who would be subjects of the study, restricting the pool to black men over the age of 25 with latent stage syphilis.[20] The selection of the Macon County African American males serves to demonstrate multiple levels of classism and racism present from the onset of the study. Dr. Clark also provided the experiment’s main rationale behind not treating the syphilitics by calling the experiment a “study in nature” and not an experiment. Claude Bernard, a famous French physiologist, outlined this distinction in 1865, saying that the “study in nature” required simple observation (a passive act) and experimentation required intervention.[21] Dr. Clark explained his decision by stating, “The state of affairs is due to the paucity of doctors, rather low intelligence of the Negro population in this section, depressed economic conditions, and the very common promiscuous sex relations of this population group which… contribute to the prevailing indifference with regard to treatment.”[22] Because of deep rooted stereotypes and prejudices black men were regarded as un-intelligent, sex-hungry, defective people. Therefore, to Clark, it became justifiable for African Americans to become test subjects. Even Dr. J. E. Moore, one of the nation’s leading venereologists, and one person who was originally a proponent of treating all syphilitic patients, agreed with Dr. Clark’s opinion on the value of African American lives. Before the study began in 1932, Moore stated, “Syphilis in the negro is in many respects almost a different disease from syphilis in the white.”[23] This assertion reflected a common thread of thinking amongst the medical professionals in the 1930’s. These ideas that black men needed different treatment that white men were based on unsubstantiated claims which were perpetuated by racist mindsets. Other medical professionals openly supported Moore’s statements. Dr. O. C. Wenger, chief of the venereal disease clinic at Hot Springs, Arkansas, expressed his support of the study and of Moore by claiming, “This study will emphasize those differences.”[24] This rationalization of the necessity and utility of the study dissuaded anyone from raising red flags about ethical or moral considerations for most of the forty-year duration of the study.

The Tuskegee Study of Untreated Syphilis in the Negro Male officially began in October, 1932. Word spread throughout Macon County that “government doctors” who had provided free exams in 1930 had returned to start a new state funded health program.[25] This was sold to the black men as the sister program of the earlier Rosenwald study. Dr. Vonderlehr had also selected Eunice Rivers, an African American woman who had studied nursing at Tuskegee Institute, to be the head nurse of the Tuskegee Study. The black men saw a familiar black face backed by a reliable government program and felt comfortable receiving the free treatments. The only medicine the men received was the occasional dose of aspirin along with vitamin pills and useless mercury salve.[26] In the summer of 1933, towards the originally scheduled end of the study, the Public Health Service sent out individual letters to the patients to bring them in for painful spinal taps. The letters read, “you have gotten a great deal of treatment for bad blood… REMEMBER THIS IS YOU LAST CAHNCE FOR SPECIAL FREE TREATMENT. BE SURE TO MEET THE NURSE.”[27] This curtain call to the syphilitics lead them to receive a painful procedure that involved a 10-inch needle being inserted into their spines without painkillers. It became infamous amongs Tuskegee Institute staff and patients as “Vonderlehr’s golden needle treatment.”[28] These taps were carried out in April and May of 1933, and at the end of June, Dr. Clark retired from the USPHS just as the Tuskegee Study was promised to end.[29] Nurse Rivers, along with an array of medical professionals all wrote letters of congratulations to Dr. Vonderlehr for a study well done.

The black men saw a familiar black face backed by a reliable government program and felt comfortable receiving the free treatments.

Dr. Vonderlehr assumed Dr. Clark’s position and very quickly made appeals to extend the study. His new goal was to obtain the autopsies of the patients. On July 18th, 1933, Vonderlehr sent a personal confidential letter to Surgeon O. C. Wenger saying, “…everyone is agreed that the proper procedure is the continuance of the observation of the Negro men used in the study with the idea of eventually bringing them to autopsy.”[30] His plan was to re-appoint Nurse Rivers to keep track of the patients, and eventually get autopsies performed on their bodies. He would remove the professional medical staff from Tuskegee, and just wait for the black syphilitics to die of their complications. Three days after Dr. Vonderlehr sent his message, Wenger responded with a confidential, hand-written letter. In it, he clearly expressed his interests; “As I see it, we have no further interest in these patients until they die.”[31] This is perhaps the clearest indication of the malicious intent behind the study. The doctors who were supposed to protect the patients were waiting for the patients to die. But for his master plan to work, Dr. Vonderlehr needed to keep the black men in Macon County and without access to real treatment.

A painful procedure known as “Vonderlehr’s Golden Needle Treatment” where spinal taps were collected for data.

Dr. Vonderlehr was very successful in keeping the black men in the dark and stagnant in Macon County. He had secured the cooperation of local physicians and the Tuskegee Institute to maintain a policy of misdirection and persuasion for a blacklist of the 400 syphilitic men who were a part of his study. Local doctors who could potentially see the men were entrusted to turn them to the Tuskegee Institute if they came looking for more treatment. In a letter to Dr. H. T. Jones, Dr. Vonderlehr wrote,

…your cooperation is sought in reporting the serious illness of any one of these Negroes past the age of 25… who consult you for a serious illness, where they were examined for bad blood by the “government doctor” at Tuskegee Institute. Your alertness in detecting these cases and immediately notifying Doctor Eugene H. Dibble, Jr., Tuskegee Institute, Alabama, will do much to make this study a success. It is doubtful whether a great deal can be accomplished without your cooperation.[32] 

In addition to informing the local doctors, Dr. Vonderlehr also exempted his patients from the draft for World War II, because he feared the military would treat them for syphilis.[33] Vonderlehr planned on keeping them ill until their deaths, and sending in health officials on a yearly basis to collect data.[34] Even after the discovery of a cure, penicillin, and its widespread availability in 1948, Dr. Vonderlehr withheld treatment. He wanted to let the study run on autopilot. Crucial to the success of this phase of the Tuskegee Study was Nurse Eunice Rivers.

Eunice Rivers held the crucial task of playing the liaison between the predominantly white medical staff and the African-American patients. She was responsible for keeping track of the study subjects and ensuring that the study could have access to the autopsies of the dead. Within the first 20 years of the study, Rivers approached 145 families and obtained autopsy rights from 144.[35] Her work was essential to the progression of the study. The question remains; did Eunice Rivers understand the full scope of the unintended consequences of the study?

The issue is not so black and white and it is unclear about the extent of Rivers’ knowledge of the nefarious nature of the study. Eunice Rivers truly believed that her involvement in the study would improve the lives of those that she affected. For each patient, she would drive the men from their homes to the Tuskegee Institute where the testing would take place. In an interview with attorney Fred D. Gray several years after the study was uncovered, Rivers recalled a part of her experiences; “In the early days, the people enjoyed the trip. It was a trip to town and a trip to Tuskegee Institute. They would come up and spend the day… me and my buddy would go to town or go on the campus to see Tuskegee Institute because there were many that had not been to Tuskegee, even though they lived in Macon County. So, they always looked forward to coming to Tuskegee and seeing us there.”[36] To Rivers and to her patients, the trip to the Institute in a fancy government car was a special outing. In an interview with historian James H. Jones, Rivers remembered, “Oh, we had a good time. We had a good time. Really and truly, when we were working with those people… that was the joy of my life.”[37]

Nurse Rivers also stood up for the black men. Unlike many of the white doctors in the study, Nurse Rivers regarded all her patients with respect. In an interview conducted by historian Lillian A. Thompson, Rivers recalls defending patients from white doctors; “They’re human. You don’t talk to them like that… If anything happens that you can’t get along; that you can’t get it through their head, just call me. We’ll straighten it out. But don’t holler at them. These are grown men.”[38] It seems as if Rivers’ relationships with the men were respectful and genuine. Yet, she still chose to continue to work for the study. Why?

 

Eunice Rivers (1899-1986) grew up as the eldest daughter in Georgia in a predominantly African American community with her father, Albert Rivers. Rivers’ mother passed away when she was just fifteen years old.[39] When Eunice Rivers was a child, her father enrolled her in a church-run boarding school in Fort Gaines, Georgia.[40] After discovering that the teaching staff was predominantly white at the school, Albert Rivers transferred his daughter to study at the Tuskegee Institute.[41]

After earning her degree in nursing from Tuskegee Institute in 1922, Rivers became a member of the Macon County’s Movable School.[42] For the next 10 years, until 1932, Eunice Rivers continued her social work with the traveling school, educating poor African Americans about proper hygiene and providing basic nursing services to the black communities.[43] Eunice Rivers’ early career was devoted to delivering aid to the poor African-American population in her state.

When looking at the social work Rivers did for the poor black population of Alabama, it would be hard to foresee her critical involvement in one of the most racist scientific studies in American history. However, several pivotal factors in River’s life lead her, an African-American nurse, to help conduct a study officially titled, “The Tuskegee Study of Untreated Syphilis in the Negro Male.”[44]

Eunice Rivers hands a bottle of iron tonic to a field worker who is part of the study.

Rivers’ time at the Tuskegee Institute deeply influenced her character. The Tuskegee Institute was founded on July 4, 1881 by a former slave owner, George Campbell, and a former slave, Lewis Adams.[45] Adams guided Alabama legislature to pass a bill that stated its primary objective was to “establish a Normal School for colored teachers at Tuskegee.”[46] He then hired Booker T. Washington, who is now widely regarded as the face of the Tuskegee Institute, to be the institution’s first principal.[47] Booker T. Washington’s political ideology bled into the Tuskegee Institute. In his famous “Atlanta Compromise” speech, he warned other black people,

Our greatest danger is that in the great leap from slavery to freedom we may overlook the fact that the masses of us are to live by the productions of our hands, and fail to keep in mind that we shall prosper in proportion as we learn to dignify and glorify common labour and put brains and skill into the common occupations of life…  No race can prosper till it learns that there is as much dignity in tilling a field as in writing a poem. It is at the bottom of life we must begin, and not at the top. Nor should we permit our grievances to overshadow our opportunities.[48]

The Tuskegee Institute’s curriculum inoculated a sense of submissiveness. Students were expected to work hard and earn their place in society. While studying at the Tuskegee Institute from 1918 to 1922, Rivers absorbed a lot of the “up by your bootstraps” mentality that was prevalent in that community.[49] This mentality likely had a visible impact on Rivers’ decision to stay with the Tuskegee Study. Historian James H. Jones noted, based from an interview he conducted with Rivers, “…her instructors at Tuskegee, especially Dr. Dibble, left no doubt in her mind what to do if a clash [between patients and doctors] did occur: obey the doctor’s orders!”[50] Following orders, especially from white doctors, was drilled into Rivers’ core.

Nurse Eunice Rivers hands out packets of aspirin to test subjects.

Nurse Rivers’ identity as a black female nurse also possibly contributed to her remaining with the study. She lived in a time where most black people were uneducated, formally, especially black women.[51] But due to her father’s strong emphasis on education, Eunice was one of the few educated black women in the medical industry.[52] In 1930, Eunice was one of only 470 black public health nurses in the nation.[53] Rivers’ position at the Tuskegee Institute and at the head of this study was of great prestige.  Not only was her position quite venerable, Rivers was also earning a good living. In a correspondence between Dr. Vonderlehr and Dr. Wenger, Vonderlehr suggests a $1,000 base salary with a $200 stipend for incidental needs for Rivers’ involvement.[54] That amounted to more than three times the yearly earnings of the dollar-a-day patients with whom she worked.

Rivers was genuinely passionate about her work. She was driven by the motivation to prove herself, and the Tuskegee study offered her a stable well-paying job that would get her through the Great Depression. Ultimately, Rivers was just a nurse, caring for her patients to the best of her ability and following the orders fed to her from above. On the other hand, baseless justifications allowed Dr. Clark and Dr. Vonderlehr to remove themselves from the true acts of horror that they would be committing. With the guilt of damning 399 black syphilitics to a life of suffering and eventual death pushed out of the way through unethical reasoning and racist beliefs, the doctors working on the study had a free conscious to do what they wanted in the name of scientific advancement. The Tuskegee Study was a flagrant abuse of power by the doctors who lead the study.

This is a blank certificate given to the participants in the study after 25 years. Participants were also given $25 with the certificate.

The “Tuskegee Study of Untreated Syphilis in the Negro Male,” is obviously a condemnable event in the history of modern medicine. The doctors who spearheaded the study melted into shadows without receiving repercussions for their crimes against humanity. But the study’s legacy remains as more than just a dark blemish in our past. The Belmont Report, a direct result of the study, establishes a set of regulations for all medical research that promote the utmost ethical standards.[55] However, African American populations still greatly distrust common “white” medicine. In a 1990 survey on the AIDS epidemic, 35% of African Americans believed that AIDS was a form of genocide.[56] James Small, a black studies professor at City College of New York explained, “Our whole relationship to [whites] had been of [their] practicing genocidal conspiratorial behavior on us from the whole slave encounter up to the Tuskegee Study.”[57] Minorities have lost their trust in government.

On May 16th, 1997, President Bill Clinton addressed the nation from The East Room in the White House. He promised the world that change would come; “No ground is gained and, indeed, much is lost if we lose our moral bearings in name of progress.”[58] But the Tuskegee Syphilis Study has left a bitter taste in our mouths. A taste that reminds us of prejudice, betrayal, and neglect.

[1]  Bill Clinton, “Apology for Tuskegee Study,” speech, May 16, 1997, Facts on File, accessed April 3, 2017, https://exeter.idm.oclc.org/login?url=http://online.infobase.com/Auth/Index?aid=14531&itemid=WE52&primarySourceId=4694.

[2] Ibid.

[3] Ibid.

[4] Jean Heller and The Associated Press, “Syphilis Victims in U.S. Study Went Untreated for 40 Years: Syphilis Victims Got No Therapy,” The New York Times (New York, NY), July 26, 1972, Front Page, accessed April 27, 2017, https://exeter.idm.oclc.org/login?url=http://search.proquest.com/docview/119530241?accountid=36348.

[5] Allan M. Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Study,” Navy Medicine, accessed April 27, 2017, http://www.med.navy.mil/bumed/Documents/Healthcare%20Ethics/Racism-And-Research.pdf.

[6] M. Tampa et al., Brief History of Syphilis, 1, accessed April 29, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/#.; Mark Rose, “Origins of Syphilis,” Archaeological Institute of America, January/February 1997, 1, accessed April 29, 2017, http://archive.archaeology.org/9701/newsbriefs/syphilis.html.

[7] Gregory E. Pence, Classic Cases in Medical Ethics: Accounts of the Cases and Issues That Define Medical Ethics, 5th ed. (Boston, MA: McGraw-Hill, 2008), 221.

[8] Tampa et al., Brief History, 1.

[9] Ibid.

[10] Sidney Olansky, Lloyd Simpson, and Stanley H. Schuman, “Environmental Factors in the Tuskegee Study of Untreated Syphilis,” Public Health Reports 66, no. 7 (July 1954): 2, accessed April 28, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2024316/?page=1.

[11]  Evelynn M. Hammonds, “Your Silence Will Not Protect You,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 49, previously published in The Black Women’s Health Book (Seattle, WA: Seal Press, 1994).

[12] James Howard Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York, NY: Free Press, 1982), 76.

[13] Ibid, 61.

[14] Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York, NY: Doubleday, 2006), 158.

[15] Charles S. Johnson, Shadow of Plantation (Chicago, Il: University of Chicago Press, 1934), 121, digital file.

[16] Pence, Classic Cases, 223.

[17] Ibid.

[18] Taliaferro Clark to J. N. Baker, August 29, 1932, in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, by Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 73.

[19]  Susan M. Reverby, “Timeline of the Study and Related Events,” Examining Tuskegee: The Infamous Syphilis Study and its Legacy, last modified November 1, 2009, accessed April 20, 2017, http://www.examiningtuskegee.com/timeline.html.

[20] Allan M. Brandt, “Racism and Research,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, by Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 18-21, previously published in The Hastings Center Report, no. 8 (December 1978): 21-29.

[21] Brandt, “Racism and Research,” in Tuskegee’s Truths, 18.

[22] Ibid, 20.

[23] Brandt, “Racism and Research,” in Tuskegee’s Truths, 20.

[24] Ibid.

[25] Fred D. Gray, The Tuskegee Syphilis Study: The Real Story and Beyond (Montgomery, AL: New South, 2002), 49.

[26] Washington, Medical Apartheid, 162.

[27] Ibid, 163.

[28] Gray, The Tuskegee, 53.

[29] Ibid, 59.; Jones, Bad Blood, 130.

[30] Raymond A. Vonderlehr to O. C. Wenger, July 18, 1933, in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, by Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 83.

[31] The original letter has the words underlined for emphasis; O. C. Wenger to Raymond A. Vonderlehr, July 21, 1933, in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 85.

[32] Raymond Vonderlehr to H. T. Jones, November 20, 1933, in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, by Susan M. Reverby, nachdr. ed. (Chapel Hill [u.a.], NC: Univ. of North Carolina Press, 2001), 86.

[33] Jones, Bad Blood, 178.

[34]Ibid, 133.

[35] Ibid, 152.

[36] Gray, The Tuskegee, 51.

[37] Jones, Bad Blood, 161.

[38] Hammonds, “Your Silence,” in Tuskegee’s Truths, 344.

[39]Facts on File, “Laurie, Eunice Rivers,” in Facts on File Encyclopedia of Black Women in America, by Darlene Clark Hine and Kathleen Thompson (Facts on File, 1998), last modified 1997, accessed April 3, 2017, http://online.infobase.com/HRC/Source/Details/5?sourceId=1040.

[40] Ibid.

[41] Vern L. Bullough and Lilli Sentz, American Nursing a Biographical Dictionary Volume 3 (New York, NY: Springer Publishing Company, 2004), 245-247.

[42] Bullough and Sentz, American Nursing, 245-247.

[43] Vern L. Bullough and Lilli Sentz, American Nursing a Biographical Dictionary Volume 3 (New York, NY: Springer Publishing Company, 2004), 245.

[44] Centers for Disease Control and Prevention, “U.S. Public Health Service Syphilis Study at Tuskegee,” Centers for Disease Control and Prevention, last modified December 8, 2016, accessed April 14, 2017, https://www.cdc.gov/tuskegee/index.html.

[45] Tuskegee University, “History of Tuskegee University,” Tuskegee University, last modified 2017, accessed April 14, 2017, http://www.tuskegee.edu/about_us/history_and_mission.aspx.

[46] National Park Service, “Tuskegee Institute,” National Park Service, accessed April 14, 2017, https://www.nps.gov/museum/exhibits/tuskegee/btwtusk.htm.

[47] Ibid.

[48] Booker T. Washington, “Atlanta Compromise,” speech, September 18, 1895, https://exeter.idm.oclc.org/login?url=http://online.infobase.com/Auth/Index?aid=14531&itemid=WE52&primarySourceId=2905.

[49] Jones, Bad Blood, 110.

[50] Ibid.

[51] Johnson, Shadow of Plantation.

[52] Gina Robertiello, “Tuskegee Syphilis Study,” in the 1940s in America, ed. Thomas Tandy Lewis (Salem, last modified 2010, http://online.salempress.com/articleDetails.do?bookId=131&articleName=1940_158340701583&searchText=tuskegee&searchOperators=any&category=History.

[53] Susan L. Smith, “Neither Victim nor Villain: Nurse Eunice Rivers, the Tuskegee Syphilis Experiment, and Public Health Work,” Journal of Women’s History 8, no. 1 (Spring 1996): 98, accessed April 25, 2017, doi:10.1353/jowh.2010.0446.

[54] Vonderlehr to Wenger, in Tuskegee’s Truths, 84.

[55] Centers for Disease Control and Prevention, “U.S. Public,” Centers for Disease Control and Prevention.

[56] Vanessa Northington Gamble, “A Legacy of Distrust: African Americans and Medical Research,” American Journal of Preventative Medicine 9, no. 6 (November/December 1993): 37, accessed April 15, 2017, https://www.researchgate.net/profile/Vanessa_Gamble/publication/15076538_A_legacy_of_distrust_African_Americans_and_medical_research/links/55ae905008aee0799220e2f0.pdf.Bottom of Form

 

[57] Ibid.

[58] Clinton, “Apology for Tuskegee,” speech, Facts on File.

 

**Bibliography available upon request

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