JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
82
head. Here he continued his investigations and in 1927 developed an improved test, a flocculation test for the diagnosis of syphilis, which, including modifications in the several years that followed, became and remained the main laboratory test for the diagnosis of syphilis in the State of Massachusetts for more than two score years. His test became widely known and was widely utilized. In 1936 Dr. Hinton published the first med6cal textbook written by any Afro-American. This was entitled "Syphilis and Its Treatment". So scholarly was his work and so effective was his ability to communicate with students, that he was elevated to the position of clinical professor of bacteriology and immunology at Harvard University in 1949 being the first of his race to attain the rank of professor in the history of Harvard University. As an index of the significance of this pioneering achievement, I must remember to ask someone before I leave how many professors Harvard has in October, 1974. It is for me a personal pleasure to have the opportunity to speak on this occasion for three reasons: First, as a person who has worked for many years in syphilology I am aware and appreciative of Dr. Hinton's legacy to medicine in this field. Secondly, for his work, in his own way, to advance the cause of human rights. A
JANUARY, 1975
modest man, he declined the proferred honor of being awarded the Spingarn Medal by the National Association for the Advancement of Colored People because, as he perceived it, his contributions to medicine were not sufficiently significant. Thirdly, as president of the National Medical Association, I am proud that one of our departed members is being honored in this fashion for his accomplishments. I commend to your attention the November 1973 issue of the Journal of the National Medical Association which was dedicated to Dr. Hinton and which contains a biographical sketch by the noted medical historian, Dr. W. Montague Cobb.* After a productive life, which included twenty-two scientific publications and many travels, Dr. Hinton died in 1959 leaving his entire modest fortune of $75,000 to his alma mater in the form of the Dwight D. Eisenhower Scholarship Fund for graduate students. Dr. William Augustus "Gus" Hinton was born of low estate, the product of the marriage of former slaves. Thriving on education and motivation he grew to become a giant of his time and a name for all time. Hence, this ceremony and this dedication is most fitting and most proper. *COBB. W.M. Will'i.m Augustus [uinton, 188349,.4111 427-428. 1957.
JNMA. v.
PROPER USES AND ABUSES OF THE HEALTH CARE DELIVERY SYSTEM FOR MINORITIES WITH SPECIAL REFERENCE TO THE TUSKEGEE SYPHILIS STUDY* VERNAL G. CAVE, M.D., FA C.P, President o/lBNation/al Medical AssociaYimlA Brookhlti, Neit1 Yolrk Since this 102nd Annual Meeting of the American Public flealth Association is focused on minority health, you have heard and will continue to hear much about the proper uses and abuses of the health care delivery system in the United States as it pertains to the poor, the disadvantaged, the deprived minorities. The proper uses of what there is of a health care system should be the same for both the minorities and the, majority of our society plus additional stakes for the minorities to address and correct the myriad factors that impact on good health. Despite pious platitudes, declarations of progress, assertions of recognition of the sacredness of human life and voiced concern for human dignity, abuses of the health care system for minorities abound. Among these is the abuse of minorities for human experimentation, sometimes for quite frivolous, poorly conceived and poorly monitored experiments, often without informed consent of the human subjects and indeed, not infrequently, without any consent of any kind. Such abuse was perpetrated by the mighty government of the United States against its own black citizenry of Macon County, Alabama in the infamous Tuskegee syphilis tragedy. Mr. Peter J. Buxton, formerly a public *v. this Journal, v 65. pp.345-348.
health advisor for the United States Public Health Service and now an attorney in California, plaved a major part in bringing this story to the attention of the general public. In August, 1972. Jean Heller of the Associated Press broke the shameful story which was flashed around the world. Since then, the startling revelations and the awesome dimensions of this crime against humanity have become widely known but the surviving victims have not been treated well by their government and abuse continues. Let us review some of the aspects of the Tuskegee tragedy which had its onset in 1933 AD. Ironically, the events that lead to this traigedy were based on a commendable endeavor launched in 1929 by the Julius Rosenwald Fund, a Chicago based philanthropic organization. The Fund set out to obtain health indices in Macon County and in five other rural counties of the South to provide the daitat to support the critical need for a progranm to upgrade the health and medical care of poor, rural blacks in the South. These counties, of which Macon County wais perhaps the poorest and most depressed, had high incidences of diseases that resulted in large measure from the poor living conditions that prevailed in the area. There were high prevalences of syphilis, tuberculosis, pellagra, malnutrition, malaria and maternal and infant mortality. Macon County, of which Tuskegee is the county
Vol. 67. No. 1
Briefs
seat, had the third highest mortality rate among the 67 rural Alabama Counties in 1929. According to the 1930 census the population of Macon County was 37,103 of which 82$ were black. The county had only one black and nine white physicians engaged in private practice. This small number was located mostly in the central and northeastern portions of the county where most of the whites lived. The average income was one to two dollars a day. Even peripheral medical service was beyond the reach of most of the inhabitants. Roads and transportation were poor. Ignorance, superstition and dependence on folk remedies all contributed to the acceptance of excessive illness and short life spans as preordained. Many were only vaguely aware of the names, consequences and treatments of diseases that were common in the area. Convulsions or seizures due to various causes were dismissed as "fits" or "spells," miscarriages or stillbirths, possibly a consequence in some cases of congenital syphilis, were accepted without any procedures being performed to determine the cause; open sores were tolerated and only a vague knowledge of tuberculosis was evident in those who saw their children's bodies wracked by coughs and emaciated by "consumption." The attitudes of the inhabitants toward life, health, illness and death reflected a high degree of resignation and fatalism. This probably was a necessary psychological adjustment to the depressing reality of the futility of expecting anything approaching adequate medical care or any improvement in all of the various factors that can make for the good life. In 1932, Macon County with its socio-economic oppression was the perfect setting for the crime that was about to be perpetrated. The Julius Rosenwald Fund program was the outgrowth of a genuine altruistic spirit. Armed with the knowledge that 35/ of 3,684 individuals tested had reactive or positive tests for syphilis it undertook the commendable effort to examine and treat these cases. The United States Public Health Service cooperated in this project. In 1932, hardpressed for finance in the time of the Great Depression, the Fund had to relinquish its efforts at syphilis control and consequently transferred its program to the Public Health Service. Before withdrawing it had succeeded in demonstrating that relatively inexpensive mass treatment for syphilis was feasible. Indeed this demonstration has remained the cornerstone of all syphilis control efforts to this very day. In October of 1932, the Public Health Service began to do its own thing on the black population of Macon County In order to get a good response, schedules announcing the clinics set up for blood collecting were publicized using churches, schools, stores and other public gathering places. A total of 4,400 males and females over 18 years of age were tested. Twenty-two per cent were found to have positive blood tests. Out of this group, 412 who were known to have received no therapy and who were males of 25 years of age or older were chosen to be the original group for this study. To this day the Public Health Service has been unable to produce any semblance of a protocol showing the objectives of the study or how those objectives were to be achieved. Indeed there is some evidence that originally only some type of short-term
83 study was contemplated. However, in 1933 another group of 200 black males of comparable ages to the first group but free of syphilis were chosen as controls. It is clear from what happened that from that point that the objective of the researchers was to follow the course of untreated syphilis through to the living end or more precisely, the dead end of the subjects. Nowhere does the record show that the 412 syphilitic individuals were told in any meaningful way exactly what disease they had and the possible dangers of not being treated. All evidence points to the likelihood that they were never told and, therefore, were not in position to give knowledgeable or informed consent for their participation in this study. They certainly were not made aware of the disabling and fatal implications of untreated syphilitic infection. To provide rapport and surveillance over the human subjects, a black nurse was employed to keep tabs on the human subjects. As members of "Miss River's Lodge," they thought of themselves as the chosen few. These unwitting victims were entitled to free medicine provided, of course, that it would not interfere with the relentless progression of their syphilitic states. This included "spring tonic," whatever in the world that might have been. The human subjects in this study were told that thev would receive free examinations from the government yearly. On these days, they would be accorded free transportation in a "government car" and free hot meals on the days of examination. A magnanimous bonus was that they would be given opportunities to stop in town on the return trips to shop or visit with friends. At some point early in the study, the Milbank Memorial Foundation agreed to pay 50 dollars toward burial if the families made available tde victims' bodies for autopsy. The final touch!
Tlhere wvas cLoftl/fotl mtiedical k0nwle/ege in 1932 (liat iintreated syphilitic infectio,, produces iliwreased1 disabilitv atid premature tnortalitv. Wlhat dhidl this stoad fifnd? This st/IdV cLOfi?tilfle(h that iutitreatect syplhilitic inlection produ(c es prem77ature m7ortalitv an7d increasedl disability. The first report on this study entitled "Untreated Syphilis in the Male Negro, a Comparative Study of Treated and Untreated Cases" by R.A. Vanderlehr and others in 1936 contained, among others, the following observations: "Only 16% of the 399 syphilitic Negroes gave no evidence of morbidity as compared with 61% of the 201 presumably nonsyphilitic Negroes. The effect of syphilis in producing disability in the early years of adult life is to be noted by comparing the cases with no demonstrable morbidity under 40 years of age. This comparison shows that only one-fourth of the Negroes with untreated syphilis had no manifestations of disease whereas three-fourths of the uninfected persons were free of manifestations." All subsequent reports represented monotonous reaffirmations that untreated syphilitic infection produces increased disability and premature mortality. It might be said that they proved a point, then proved a point, then proved a point. To quote Gertrude Stein, "A Rose is a rose, is a rose, is a rose." In 1946, 14 years of non-treatment had elapsed. Penicillin, hailed as the miracle drug, was then available
84
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
and utilized for the treatment of syphilis. At this time 25'S, of the syphilitic group aind 14/% of' the controls of' comparable ages had died. It was calculated by aictuaries that at aige 25 black maile syphilitics allowed to remain untreated would have reduction in life expectancy of' approximately 20/. Still the patients went untreated. The Public Hlealth Service even continued to fail to treat for months after unanimous recommendation for immediate discontinuance of the study was made by the nine member Ad Hoc Tuskegee Syphilis Study Advisory Panel appointed on August 28, 1972 by Dr. Merlin K. Duval, Assistant Secretary for Health & Scientific Affairs of the Depatment of Health, Education and Welfare. This in capsular form is an account of one of the flagrant abuses of the health delivery system. It is an exploitation in our nation's history whose immorality is so obvious that it can be quickly perceived by any but the hopelessly inconvertible bigots. All the survivors have now been located by the Public Health Service and have been offered the best medical care for the rest of their lives. But outrageously, the government is denying compensation to the victims. They have forced those who seek compensation into lengthy litigation. One would have thought that there would by now be federal legislative and executive agreement to compensate these aged victims rather than subjecting them to prolonged and agonizing trials. Yet this is the current status. What should be done about this patient abuse'? I offer a few suggestions: A. PREI VENTION * Prevention reqLlir-es deillillg with the root Ltises that make poor people sLsIeSlihlelo experimental hunilll explioitation -ipovert. ignOriiltce. poor 11OLISing. Utnemployment. mlllulliltritioii. and nlow imlore recentl1 illlatlionl. to iiletilioti al 1ew. It was sta.ted in onie of the reports by soImle
JANUARY, 1975
of' the reseairchers in this studytlliit becLaIse ol' their ltick 01' education, hle hum.1aniin suLhiecis Could 1oi he IIIoliv iied hr explatiningg io hliemil thlat thero wold he contrih-tinig to huImnitnyt% hr talkinig part in this sItLud. Whatl iron!! YouL Ci'il he sLire tihalt il' the opposite con(litioni existe(l tlhalt is, if' tllCSe huImlallil stLh'iects were well e(dLtlle(l. thet likewise Cotuld nol he lpersLadIe(l to he sactrilicial laimibs l'or the rest ol Itu11.iiniatv I. L l(iISLAATION I-egislatlioll is 1now pending to estalblish at Nattionlal Cominitlissiott I'or the Protectiotin l'iif1lilil SuLhiecis oI' Bioime(licll and Behalviotral Reseairch. This legisliiioln shouL(l he pushed and it shOLitl( cOntiaill atll or imuost of' the recoimimlend(latiotis oif the d lotc Tuskegee Syphilis Stutidy Advisorv Painel This woul(i inldCILKe whallt ciii; be calile(d iotiitiudsiliellt ati the local levels to initerpret f'or poitenltial stLthiets oi' hUtniti exlerliltenitatiton iLSI what they aire gettitig therinselves inito. C. (COM PNSATION * AdeqUtate CometisatittiO l'or the t'lm1ilies anid the surviving victimns shotil(l be itiad(le anid it shioul( be (loite ilow. With all oI' the reaitalinig victitits in the late evettilngs of' their lives. Arierica hats otluti venr shoru timiie lel'i toiiimake soitme type ofiilimt;eriail aimiiend.ls tha,t cii, still be enijoyred hr these victris. YOiU anl(d canii both cite examliles of' how speedliV otuI goverimilletit ciii; actl when it cotisiders it imilliortant to (to so. Il woLild he extremitely heltpful il' ai resolution on this subject coul(l conile out ol' the uleliberaitiotis of' the ioverining Council of' the Aiiterictii P'ublic lealili Associatioin att this session. 1) REC-RUITMENT * Recruitment. training and reletitioin of' miniority lersoinnel in the heailth field is at imlust. I[or how else rio riou get physicianis anld other healilh workers in the Macton counties of' our land') low else dloiOI get a sufficient supply of health personnel to meet the needs of our indigent minorities in our urban ghettoes? And finally, F. MINORITY PARTICIPATION * woulrt suggest thtil this is at sigigal exaimple of the tiee(d for iiitioritr participation in every airet oif (lecisioti ima;lkinig in goveriirnleniital iltvolvemilenit in heatlth. It is dtillicult to cotlceive that oLir histiory Woriuld hare beenl staiitedl bh the Tuskegee Tragedy if' there har been minoirity representationi when p[Iins lor this study were hatche( its 1932 Ouir e01tinialillt push lor involvement is based iiot 0111tnlytn oir (lesire to have a piece oI the actliotin at every level hut iimore intiporlaniltr oii particular poinits Of iew that we canii bring to any (leliberattionls halse(d otl lie imiilieu froiii which we ctnile
We can reduce the abuses and increase the proper uses of the health care delivery system for minorities. If we can move meaningfully on what is herein suggested, the victims of this American tragedy may become "Unknown Heroes for Change" who gave their lives so that others might live. May this be for all people everywhere.
TERRENCE TESTIMONIAL BANQUET Dr. August Caswell Terrence, 55th president of the National Medical Association in 1955-56,* was tendered a
Dr. Terrence making point at New Orleans NMA Convention. testimonial banquet on March 30, 1974, in the Downtowner Hotel of his home city of Opelousas, Louisiana, *For additional
biogr.phical data see this Journal. v. 46. pp. 422. 442,
aind the Souvenir Program of' the Testimonial Banquet.
1954,
where he has been a general practitioner since 1931. The dinner was in recognition of Dr. Terrence's dedicated services in many capacities in Opelousas since he entered practice there. Born in New Orleans in 1900, he received his early education there, was awarded the B.S. and M.D. by Howard University, the latter in 1928. He served his internship at St. Agnes Hospital, Raleigh, North Carolina. His numerous awards include: the Howard University Distinguished Alumni Medal, 1957; the Louisiana Teachers Award, 1956; and the Service Awards of Frontiers International, 1971, and the Chi Delta Mu Fraternity, 1973. He was president of the Louisiana Medical Association, 1937-42, and served the NMA as assistant general secretary, 1933-39; director of publicity, 1939-45, and secretary of the Board of Trustees, 1952-54, before elevation to the presidency. He has also been active in Howard alumni activities, having been a member of the Executive Committee of the General Alumni Council and is currently president of the, New Orleans Chapter. Dr. Terrence is an officer or director of numerous philanthropic, professional and business organizations. The testimonial banquet was under the auspices of the United Citizens for Cultural Advancement, a local
82
head. Here he continued his investigations and in 1927 developed an improved test, a flocculation test for the diagnosis of syphilis, which, including modifications in the several years that followed, became and remained the main laboratory test for the diagnosis of syphilis in the State of Massachusetts for more than two score years. His test became widely known and was widely utilized. In 1936 Dr. Hinton published the first med6cal textbook written by any Afro-American. This was entitled "Syphilis and Its Treatment". So scholarly was his work and so effective was his ability to communicate with students, that he was elevated to the position of clinical professor of bacteriology and immunology at Harvard University in 1949 being the first of his race to attain the rank of professor in the history of Harvard University. As an index of the significance of this pioneering achievement, I must remember to ask someone before I leave how many professors Harvard has in October, 1974. It is for me a personal pleasure to have the opportunity to speak on this occasion for three reasons: First, as a person who has worked for many years in syphilology I am aware and appreciative of Dr. Hinton's legacy to medicine in this field. Secondly, for his work, in his own way, to advance the cause of human rights. A
JANUARY, 1975
modest man, he declined the proferred honor of being awarded the Spingarn Medal by the National Association for the Advancement of Colored People because, as he perceived it, his contributions to medicine were not sufficiently significant. Thirdly, as president of the National Medical Association, I am proud that one of our departed members is being honored in this fashion for his accomplishments. I commend to your attention the November 1973 issue of the Journal of the National Medical Association which was dedicated to Dr. Hinton and which contains a biographical sketch by the noted medical historian, Dr. W. Montague Cobb.* After a productive life, which included twenty-two scientific publications and many travels, Dr. Hinton died in 1959 leaving his entire modest fortune of $75,000 to his alma mater in the form of the Dwight D. Eisenhower Scholarship Fund for graduate students. Dr. William Augustus "Gus" Hinton was born of low estate, the product of the marriage of former slaves. Thriving on education and motivation he grew to become a giant of his time and a name for all time. Hence, this ceremony and this dedication is most fitting and most proper. *COBB. W.M. Will'i.m Augustus [uinton, 188349,.4111 427-428. 1957.
JNMA. v.
PROPER USES AND ABUSES OF THE HEALTH CARE DELIVERY SYSTEM FOR MINORITIES WITH SPECIAL REFERENCE TO THE TUSKEGEE SYPHILIS STUDY* VERNAL G. CAVE, M.D., FA C.P, President o/lBNation/al Medical AssociaYimlA Brookhlti, Neit1 Yolrk Since this 102nd Annual Meeting of the American Public flealth Association is focused on minority health, you have heard and will continue to hear much about the proper uses and abuses of the health care delivery system in the United States as it pertains to the poor, the disadvantaged, the deprived minorities. The proper uses of what there is of a health care system should be the same for both the minorities and the, majority of our society plus additional stakes for the minorities to address and correct the myriad factors that impact on good health. Despite pious platitudes, declarations of progress, assertions of recognition of the sacredness of human life and voiced concern for human dignity, abuses of the health care system for minorities abound. Among these is the abuse of minorities for human experimentation, sometimes for quite frivolous, poorly conceived and poorly monitored experiments, often without informed consent of the human subjects and indeed, not infrequently, without any consent of any kind. Such abuse was perpetrated by the mighty government of the United States against its own black citizenry of Macon County, Alabama in the infamous Tuskegee syphilis tragedy. Mr. Peter J. Buxton, formerly a public *v. this Journal, v 65. pp.345-348.
health advisor for the United States Public Health Service and now an attorney in California, plaved a major part in bringing this story to the attention of the general public. In August, 1972. Jean Heller of the Associated Press broke the shameful story which was flashed around the world. Since then, the startling revelations and the awesome dimensions of this crime against humanity have become widely known but the surviving victims have not been treated well by their government and abuse continues. Let us review some of the aspects of the Tuskegee tragedy which had its onset in 1933 AD. Ironically, the events that lead to this traigedy were based on a commendable endeavor launched in 1929 by the Julius Rosenwald Fund, a Chicago based philanthropic organization. The Fund set out to obtain health indices in Macon County and in five other rural counties of the South to provide the daitat to support the critical need for a progranm to upgrade the health and medical care of poor, rural blacks in the South. These counties, of which Macon County wais perhaps the poorest and most depressed, had high incidences of diseases that resulted in large measure from the poor living conditions that prevailed in the area. There were high prevalences of syphilis, tuberculosis, pellagra, malnutrition, malaria and maternal and infant mortality. Macon County, of which Tuskegee is the county
Vol. 67. No. 1
Briefs
seat, had the third highest mortality rate among the 67 rural Alabama Counties in 1929. According to the 1930 census the population of Macon County was 37,103 of which 82$ were black. The county had only one black and nine white physicians engaged in private practice. This small number was located mostly in the central and northeastern portions of the county where most of the whites lived. The average income was one to two dollars a day. Even peripheral medical service was beyond the reach of most of the inhabitants. Roads and transportation were poor. Ignorance, superstition and dependence on folk remedies all contributed to the acceptance of excessive illness and short life spans as preordained. Many were only vaguely aware of the names, consequences and treatments of diseases that were common in the area. Convulsions or seizures due to various causes were dismissed as "fits" or "spells," miscarriages or stillbirths, possibly a consequence in some cases of congenital syphilis, were accepted without any procedures being performed to determine the cause; open sores were tolerated and only a vague knowledge of tuberculosis was evident in those who saw their children's bodies wracked by coughs and emaciated by "consumption." The attitudes of the inhabitants toward life, health, illness and death reflected a high degree of resignation and fatalism. This probably was a necessary psychological adjustment to the depressing reality of the futility of expecting anything approaching adequate medical care or any improvement in all of the various factors that can make for the good life. In 1932, Macon County with its socio-economic oppression was the perfect setting for the crime that was about to be perpetrated. The Julius Rosenwald Fund program was the outgrowth of a genuine altruistic spirit. Armed with the knowledge that 35/ of 3,684 individuals tested had reactive or positive tests for syphilis it undertook the commendable effort to examine and treat these cases. The United States Public Health Service cooperated in this project. In 1932, hardpressed for finance in the time of the Great Depression, the Fund had to relinquish its efforts at syphilis control and consequently transferred its program to the Public Health Service. Before withdrawing it had succeeded in demonstrating that relatively inexpensive mass treatment for syphilis was feasible. Indeed this demonstration has remained the cornerstone of all syphilis control efforts to this very day. In October of 1932, the Public Health Service began to do its own thing on the black population of Macon County In order to get a good response, schedules announcing the clinics set up for blood collecting were publicized using churches, schools, stores and other public gathering places. A total of 4,400 males and females over 18 years of age were tested. Twenty-two per cent were found to have positive blood tests. Out of this group, 412 who were known to have received no therapy and who were males of 25 years of age or older were chosen to be the original group for this study. To this day the Public Health Service has been unable to produce any semblance of a protocol showing the objectives of the study or how those objectives were to be achieved. Indeed there is some evidence that originally only some type of short-term
83 study was contemplated. However, in 1933 another group of 200 black males of comparable ages to the first group but free of syphilis were chosen as controls. It is clear from what happened that from that point that the objective of the researchers was to follow the course of untreated syphilis through to the living end or more precisely, the dead end of the subjects. Nowhere does the record show that the 412 syphilitic individuals were told in any meaningful way exactly what disease they had and the possible dangers of not being treated. All evidence points to the likelihood that they were never told and, therefore, were not in position to give knowledgeable or informed consent for their participation in this study. They certainly were not made aware of the disabling and fatal implications of untreated syphilitic infection. To provide rapport and surveillance over the human subjects, a black nurse was employed to keep tabs on the human subjects. As members of "Miss River's Lodge," they thought of themselves as the chosen few. These unwitting victims were entitled to free medicine provided, of course, that it would not interfere with the relentless progression of their syphilitic states. This included "spring tonic," whatever in the world that might have been. The human subjects in this study were told that thev would receive free examinations from the government yearly. On these days, they would be accorded free transportation in a "government car" and free hot meals on the days of examination. A magnanimous bonus was that they would be given opportunities to stop in town on the return trips to shop or visit with friends. At some point early in the study, the Milbank Memorial Foundation agreed to pay 50 dollars toward burial if the families made available tde victims' bodies for autopsy. The final touch!
Tlhere wvas cLoftl/fotl mtiedical k0nwle/ege in 1932 (liat iintreated syphilitic infectio,, produces iliwreased1 disabilitv atid premature tnortalitv. Wlhat dhidl this stoad fifnd? This st/IdV cLOfi?tilfle(h that iutitreatect syplhilitic inlection produ(c es prem77ature m7ortalitv an7d increasedl disability. The first report on this study entitled "Untreated Syphilis in the Male Negro, a Comparative Study of Treated and Untreated Cases" by R.A. Vanderlehr and others in 1936 contained, among others, the following observations: "Only 16% of the 399 syphilitic Negroes gave no evidence of morbidity as compared with 61% of the 201 presumably nonsyphilitic Negroes. The effect of syphilis in producing disability in the early years of adult life is to be noted by comparing the cases with no demonstrable morbidity under 40 years of age. This comparison shows that only one-fourth of the Negroes with untreated syphilis had no manifestations of disease whereas three-fourths of the uninfected persons were free of manifestations." All subsequent reports represented monotonous reaffirmations that untreated syphilitic infection produces increased disability and premature mortality. It might be said that they proved a point, then proved a point, then proved a point. To quote Gertrude Stein, "A Rose is a rose, is a rose, is a rose." In 1946, 14 years of non-treatment had elapsed. Penicillin, hailed as the miracle drug, was then available
84
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
and utilized for the treatment of syphilis. At this time 25'S, of the syphilitic group aind 14/% of' the controls of' comparable ages had died. It was calculated by aictuaries that at aige 25 black maile syphilitics allowed to remain untreated would have reduction in life expectancy of' approximately 20/. Still the patients went untreated. The Public Hlealth Service even continued to fail to treat for months after unanimous recommendation for immediate discontinuance of the study was made by the nine member Ad Hoc Tuskegee Syphilis Study Advisory Panel appointed on August 28, 1972 by Dr. Merlin K. Duval, Assistant Secretary for Health & Scientific Affairs of the Depatment of Health, Education and Welfare. This in capsular form is an account of one of the flagrant abuses of the health delivery system. It is an exploitation in our nation's history whose immorality is so obvious that it can be quickly perceived by any but the hopelessly inconvertible bigots. All the survivors have now been located by the Public Health Service and have been offered the best medical care for the rest of their lives. But outrageously, the government is denying compensation to the victims. They have forced those who seek compensation into lengthy litigation. One would have thought that there would by now be federal legislative and executive agreement to compensate these aged victims rather than subjecting them to prolonged and agonizing trials. Yet this is the current status. What should be done about this patient abuse'? I offer a few suggestions: A. PREI VENTION * Prevention reqLlir-es deillillg with the root Ltises that make poor people sLsIeSlihlelo experimental hunilll explioitation -ipovert. ignOriiltce. poor 11OLISing. Utnemployment. mlllulliltritioii. and nlow imlore recentl1 illlatlionl. to iiletilioti al 1ew. It was sta.ted in onie of the reports by soImle
JANUARY, 1975
of' the reseairchers in this studytlliit becLaIse ol' their ltick 01' education, hle hum.1aniin suLhiecis Could 1oi he IIIoliv iied hr explatiningg io hliemil thlat thero wold he contrih-tinig to huImnitnyt% hr talkinig part in this sItLud. Whatl iron!! YouL Ci'il he sLire tihalt il' the opposite con(litioni existe(l tlhalt is, if' tllCSe huImlallil stLh'iects were well e(dLtlle(l. thet likewise Cotuld nol he lpersLadIe(l to he sactrilicial laimibs l'or the rest ol Itu11.iiniatv I. L l(iISLAATION I-egislatlioll is 1now pending to estalblish at Nattionlal Cominitlissiott I'or the Protectiotin l'iif1lilil SuLhiecis oI' Bioime(licll and Behalviotral Reseairch. This legisliiioln shouL(l he pushed and it shOLitl( cOntiaill atll or imuost of' the recoimimlend(latiotis oif the d lotc Tuskegee Syphilis Stutidy Advisorv Painel This woul(i inldCILKe whallt ciii; be calile(d iotiitiudsiliellt ati the local levels to initerpret f'or poitenltial stLthiets oi' hUtniti exlerliltenitatiton iLSI what they aire gettitig therinselves inito. C. (COM PNSATION * AdeqUtate CometisatittiO l'or the t'lm1ilies anid the surviving victimns shotil(l be itiad(le anid it shioul( be (loite ilow. With all oI' the reaitalinig victitits in the late evettilngs of' their lives. Arierica hats otluti venr shoru timiie lel'i toiiimake soitme type ofiilimt;eriail aimiiend.ls tha,t cii, still be enijoyred hr these victris. YOiU anl(d canii both cite examliles of' how speedliV otuI goverimilletit ciii; actl when it cotisiders it imilliortant to (to so. Il woLild he extremitely heltpful il' ai resolution on this subject coul(l conile out ol' the uleliberaitiotis of' the ioverining Council of' the Aiiterictii P'ublic lealili Associatioin att this session. 1) REC-RUITMENT * Recruitment. training and reletitioin of' miniority lersoinnel in the heailth field is at imlust. I[or how else rio riou get physicianis anld other healilh workers in the Macton counties of' our land') low else dloiOI get a sufficient supply of health personnel to meet the needs of our indigent minorities in our urban ghettoes? And finally, F. MINORITY PARTICIPATION * woulrt suggest thtil this is at sigigal exaimple of the tiee(d for iiitioritr participation in every airet oif (lecisioti ima;lkinig in goveriirnleniital iltvolvemilenit in heatlth. It is dtillicult to cotlceive that oLir histiory Woriuld hare beenl staiitedl bh the Tuskegee Tragedy if' there har been minoirity representationi when p[Iins lor this study were hatche( its 1932 Ouir e01tinialillt push lor involvement is based iiot 0111tnlytn oir (lesire to have a piece oI the actliotin at every level hut iimore intiporlaniltr oii particular poinits Of iew that we canii bring to any (leliberattionls halse(d otl lie imiilieu froiii which we ctnile
We can reduce the abuses and increase the proper uses of the health care delivery system for minorities. If we can move meaningfully on what is herein suggested, the victims of this American tragedy may become "Unknown Heroes for Change" who gave their lives so that others might live. May this be for all people everywhere.
TERRENCE TESTIMONIAL BANQUET Dr. August Caswell Terrence, 55th president of the National Medical Association in 1955-56,* was tendered a
Dr. Terrence making point at New Orleans NMA Convention. testimonial banquet on March 30, 1974, in the Downtowner Hotel of his home city of Opelousas, Louisiana, *For additional
biogr.phical data see this Journal. v. 46. pp. 422. 442,
aind the Souvenir Program of' the Testimonial Banquet.
1954,
where he has been a general practitioner since 1931. The dinner was in recognition of Dr. Terrence's dedicated services in many capacities in Opelousas since he entered practice there. Born in New Orleans in 1900, he received his early education there, was awarded the B.S. and M.D. by Howard University, the latter in 1928. He served his internship at St. Agnes Hospital, Raleigh, North Carolina. His numerous awards include: the Howard University Distinguished Alumni Medal, 1957; the Louisiana Teachers Award, 1956; and the Service Awards of Frontiers International, 1971, and the Chi Delta Mu Fraternity, 1973. He was president of the Louisiana Medical Association, 1937-42, and served the NMA as assistant general secretary, 1933-39; director of publicity, 1939-45, and secretary of the Board of Trustees, 1952-54, before elevation to the presidency. He has also been active in Howard alumni activities, having been a member of the Executive Committee of the General Alumni Council and is currently president of the, New Orleans Chapter. Dr. Terrence is an officer or director of numerous philanthropic, professional and business organizations. The testimonial banquet was under the auspices of the United Citizens for Cultural Advancement, a local
