American Scandal - Tuskegee Syphilis Study - First, Do No Harm | 1

Episode Date: June 11, 2019

In early 1930s America, segregation is the law of the land, and syphilis remains a grave public health concern. A handful of white government doctors aims to treat African Americans in a rural Alabama county where infection rates are especially high. But several officials conspire to alter the program’s goals, launching a decades-long program that will stain medical history.Need more American Scandal? With Wondery+, enjoy exclusive seasons, binge new seasons first, and listen completely ad-free. Start your free trial in the Wondery App, Apple Podcasts, Spotify or visit https://wondery.app.link/rUic7i1hMNb now.  See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

You're listening to the first episode of this American Scandal season. With Wondery+, you can binge the remaining episodes, listen to new episodes early, and explore more exclusive seasons completely ad-free. Start your free trial of Wondery Plus in the Wondery app, Apple Podcasts, or Spotify today. A listener note. This series is about a shameful chapter in American history. As part of telling the story accurately, we present the point of view of doctors and others from the period who express racist and white supremacist views. Listener discretion is advised. July 1972, San Francisco, California. It's a pleasant summer evening at a pleasant dinner party in a pleasant apartment

filled with chit-chat and shop talk. An international affairs reporter with the Associated Press named Edith Lederer breaks away from her conversation to refill her wine glass. Lederer scans the living room. Everyone appears to be having fun. Everyone except the lone man by the window staring out at the living room. Everyone appears to be having fun. Everyone except the lone man by the window, staring out at the city lights. After a minute, she recognizes him, an acquaintance, Peter Buxton. She walks over. awkward pause. Edith, do you know how I came to this country? I thought you grew up in Oregon. I did, but I was born in Czechoslovakia in 37. My father was Jewish, so we ran. I bring this up because I think you should know that something very similar to Nazi science is being practiced here in America.

Today. Lederer swallows hard. No more casual sips from her wine glass. She's all ears. What are you talking about? It was just a random morning. I was in the coffee room. This was back when I tracked venereal disease for the U.S. Public Health Service. A couple colleagues were chatting, and one mentioned a patient in Alabama.

This man had terrible symptoms, he said. He was plainly insane. The family was scared, so they took him to a doctor they knew. And after a brief examination, the diagnosis was made. Syphilis. Tertiary stage. The doctor gave him a shot of penicillin, sent him home. But when the higher-ups at the PHS found out about the treatment, they were angry. Angry? Why?

Because the doctor treated a man who was not supposed to be treated. Not supposed to... Now wait, I don't understand. The CDC, the Surgeon General, the State Board of Health, they're all in on it. Peter, in on what? The experiment. He is for 40 years.

PHS has been experimenting on black men in Macon County, Alabama. In the beginning, there were over 600 test subjects. Now there's less than 100. The rest are, yeah, dead or unaccounted for. None of them know they have syphilis. The doctors running the study, they didn't tell them. They just let them die. They want to see what happens when syphilis goes untreated in a man's body.

Right up until the moment it kills him. They even pay for burial costs. Peter, that can't be true. No one would do that. It is impossible. I can prove it. I have all the charts, all the reports. They're not even trying to hide it.

They don't think they're doing anything wrong. The test subjects are all black people? All of them? Every last one. And the study will continue until every last one dies. Unless someone does something. Anita, I've tried. I've tried. But I need your help.

This has to be exposed. Lederer's head is spinning. She finds the nearest coffee table and sets her glass down. Peter, I want to see everything you have on this. Tonight. Right now. Lederer and Buxton depart that night for Buxton's home. Once there, Lederer leaves through inter-office letters, roundup reports, x-ray descriptions, autopsy photos. Her eyes widen at phrases like,

We are keeping the known positive patients from getting treatment. And, Arrange for autopsy those who die in the future. She takes everything she can carry and starts making copies. The experiment is called the Tuskegee Study of Untreated Syphilis in the Negro Male. It's the longest-running non-therapeutic experiment on human beings in the history of medicine. Relatively few people in the medical community are aware of it. Even fewer have questioned it. Until now, most people have had no idea it's happening,

especially not the test subjects. But the doctors slowly killing them are thrilled with their results. In the past decade, Boeing has been involved in a series of scandals and deadly crashes that have dented its once sterling reputation. At the center of it all, the 737 MAX, the latest season of business wars, explores how Boeing allowed things to turn deadly and what, if anything, can save the company's reputation. Make sure to listen to Business Wars wherever you get your podcasts.

From Wondery, I'm Lindsey Graham, and this is American Scandal. Informed consent, truthful disclosure of diagnosis and test results. These are things we come to expect from our doctors, and today, in the United States, it's illegal to conduct a medical study involving human participants unless these conditions are met. The rules were signed into law in 1974 in response to the Tuskegee experiments. Syphilis is a sexually transmitted disease that, if left untreated, can cause blindness, stroke, heart trouble, insanity, and death. In the early 20th century, it was a massive public health concern, poorly understood,

and until 1945, largely incurable. Beginning in 1932, more than 400 black men were recruited to participate in a study on the effects of syphilis. In the coming years, another 200 men were recruited as controls. The issue was, none of the patients knew that they were part of a study. The infected ones didn't even know they had syphilis. Instead, the sick men were told that they had bad blood and would need regular testing and treatment. No more specific diagnosis was ever given, and the promised treatment never arrived. Many were allowed to die when they could easily have been cured. The question is why.

This is Episode 1. First, do no harm. Do no harm. It's April 1929 when Michael Davis steps briskly into the well-appointed office of the United States Public Health Service, or PHS. Though white-haired and nearly 50 years old, Davis still has the drive and focus of a young visionary at the start of his career. And today, he's got a big vision. He's here to see Hugh S. Cumming, the PHS Surgeon General. Not long ago, Davis joined the Rosenwald Fund,

a private charitable organization started by Sears co-owner Julius Rosenwald for the well-being of mankind. The son of Jewish immigrants, Rosenwald had poured millions into schools, museums, and charities, and taken a special interest in helping America's Black communities. Davis is the fund's new director of medical services, charged with collaborating with PHS to develop Black health programs. This is what he plans to discuss with Cumming. Settling into a plush office chair, Davis outlines his agenda. Segregation is still very much the law of the land, but, he tells Cumming, a lot has changed. In the old days, the philosophy was that since blacks lived sinful lifestyles, they got illnesses like venereal disease and deserved what came next.

Discomfort, physical disfigurement, even death. Luckily, he continues, such medieval thinking is a thing of the past. Enlightened doctors now understand that improving black public health will improve health for everyone. So, and now Davis is excited, it's time to get more Black people into medicine. Train these workers to treat the citizens of their community. Gesturing as he speaks, Davis calls for the hiring of Black nurses,

physicians, and sanitary inspectors. He tells Cumming he wants money invested in the construction of Black medical facilities, the establishment of scholarships that will promote Black public health training. He concludes by saying they'll focus on rural Blacks in the South and partnering with the Tuskegee Institute in Alabama,

a Black university co-founded by Booker T. Washington. With his pitch concluded, Davis sits back, satisfied. After a minute, Cumming nods, says he likes what he's heard. He tells Davis they'll get started right away. A thousand miles away in Bolivar County, Mississippi, Dr. Oliver Clarence Wenger smiles to himself as another long day at his health clinic draws to a close. It's early September, 1929, and even though it's a Saturday, there's no place he'd rather be.

He helps one of the doctors sort the many vials of blood samples collected this afternoon, even more than the day before. And that's good. Looks like he'll be able to complete testing ahead of schedule. Wenger came to Mississippi following his success as director of the PHS Venereal Disease Clinic in Hot Springs, Arkansas. His clinics cater to local Black communities, and Wenger's proud of that. As a white doctor in the South, he sees himself as something of a shepherd. His patients are like children, he explains to friends. All they need is a little guidance, and it's guidance

he's happy to give. He spends his days improving their health, drawing their blood for analysis, and administering injections and ointments to help them feel better. It's satisfying work. Plus, these people really are a hoot. Loading the blood into a truck, Wenger chuckles to himself, recalling what just happened to Dr. Brevard. Two Negroes approached Brevard and said they felt weak after having their blood drawn the previous day. Specifically, they felt that their sexual powers had been impaired.

Dr. Brevard nodded, stroked his chin, then proposed a solution. Would the Negroes like their blood back? Their eyes lit up, yes, they would. Brevard excused himself, then returned with a one-ounce bag of red-colored placebo. He solemnly advised the Negroes to take the mixture in teaspoon-full doses. They promised they would and departed with no further complaint. Amazing. Harmless jokes aside, though, for years,

Wenger has believed that medicine is letting Black people down. And he wants to do his part to end the neglect. So he was thrilled when the U.S. Public Health Service sent him here to Mississippi. His mission is to oversee syphilis testing for 2,000 Black locals working for the Delta and Pine Land Company. So far, he's found that nearly a quarter of the company's Black employees carry the disease. That revelation has led to what Wenger considers another leap forward, a syphilis treatment program funded by the PHS. If it works, it could be replicated in other towns across the country. Wenger's been running this program, too.

But he's only a month in, and it's hard work. The days are brutally hot, and the medical facilities are hastily constructed and barely adequate. The infected men can't be cured. Right now, there is no cure. Wenger's confident there's one right around the corner, but for now, that research process is too expensive and time-consuming. So Wenger and his partner do the best they can with drugs that render the men non-infectious. They can at least keep other people from getting the disease.

And just as they'd hoped, the program is a success. The PHS does decide to expand it. So Dr. Wenger happily heads to Alabama, launching another large-scale anti-syphilis effort for the benefit of rural Blacks. And they need his help. Even after years of this work, Wenger can't believe how poor they really are. Black sharecroppers and rags, still coated in dirt from the fields. Roomy eyes, missing teeth, but still smiling away. How could anyone live like this?

It's a mild winter afternoon in February 1930. The rough and dirty men are lined up at the Possum Hollow School in Macon County, Alabama. And by the looks of them, they're lucky to have someone like Wenger to save them from themselves. They even have one of their own, a black doctor named Clyde Frost from the Rosenwald Fund, attending to the men in line. Dr. Frost hands a vial of recently collected blood to a nurse, sees Wenger watching him, and nods. Wenger walks over as Frost sends a patient on his way. Now take care of yourself, and don't forget, you know anyone who hasn't been seen by us yet, you be sure to tell them to come by.

Looks like the testing is going smoothly, Dr. Frost. I'm impressed. Many of these men have never seen a doctor. They're happy to see any medical attention. Grateful to receive treatment for the first time in their lives. And you're keeping them in the dark, right? We're here to prove to this country's doctors that the disease can be controlled among rural blacks. What we're sure as hell not here to do is give these people an education in venereal disease and the facts of life.

Yes, yes, sir. It's important we don't confuse these people with words they don't know and don't need to know. Words like syphilis. No one here has said that word, myself included. We're sticking to the approved terminology. We just tell them that they have bad blood and need medicine, which we provide. Excellent. We're trying to keep this all running as smoothly as possible. The fewer needless conversations, the better. Frost, can I ask you something? Of course, Dr. Wenger. These Negroes

are extremely trusting. They do almost anything we ask. No whining, no questions. Now, this seems to be a common trait amongst Negroes. Can you explain it? Frost takes his time. Wenger can see that he seems to be struggling to find the words. Well, I think that the people here are naturally kind, and they seem very trusting of whites.

Considering how whites treat them down here, that's surprising to me. Well, Dr. Wenger, they've learned to obey authority figures. Fascinating. Well, I'll let you get back to it, Dr. Frost. Keep up the good work. Wenger walks away, thinking about that last exchange. The people here believe in doing what white people tell them to do. They ask very few questions.

He's here to test syphilis, and in more ways than one, he's found the ideal test subjects. He looks towards the door as more and more black men enter. If they are this open to suggestion, perhaps there are other purposes they might serve. Perhaps they can be driven to make great sacrifices in the name of science without even knowing it. On January 5th, 2024, an Alaska Airlines door plug tore away mid-flight, leaving a gaping hole in the side of a plane that carried 171 passengers. This heart-stopping incident was just the latest in a string of crises surrounding the

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Now, follow Business Wars on the Wondery app or wherever you get your podcasts. You can binge Business Wars, the unraveling of Boeing, early and ad-free right now on Wondery+. I'm Jake Warren, and in our first season of Finding, I set out on a very personal quest to find the woman who saved my mom's life. You can listen to Finding Natasha right now exclusively on Wondery Plus. In season two, I found myself caught up in a new journey to help someone I've never even met. But a couple of years ago, I came across a social media post by a person named Loti.

It read in part, Three years ago today that I attempted to jump off this bridge, but this wasn't my time to go. A gentleman named Andy saved my life. I still haven't found him. This is a story that I came across purely by chance, but it instantly moved me, and it's taken me to a place where I've had to consider

some deeper issues around mental health. This is season two of Finding, and this time, if all goes to plan, we'll be finding Andy. You can listen to Finding Andy and Finding Natasha exclusively and ad-free on Wondery Plus. Join Wondery Plus in the Wondery app, Apple Podcasts, or Spotify. It's March, 1930. Dr. Wenger's testing in Macon County has come to an end. And on a chilly day in the nation's capital,

the newly hired PHS advisor to the Rosenwald Fund pours over Wenger's results. At his desk, he makes urgent notes in the margins. His name is Dr. Tolliver Clark, and his family roots date back all the way to colonial Virginia, which is why, as a true Southerner, he doesn't find the statistics for Macon County all that shocking. 36% of the blacks tested have syphilis. That's nearly 8,000 people.

He double-checks the data, sees that it must be accurate. He's fascinated by the numbers, energized and intrigued by them, and he has some ideas of his own about how to proceed. Which is why he's invited the Rosenwald Fund's Michael Davis to his office to discuss the findings. Davis is aware of the data coming out of Alabama, and it worries him. Clark knows that Davis has taken issue with aspects of Wenger's treatment program, not with his methods or its conclusions, but something else. Clark can sense a certain sentimentality in Davis. It's not a sentimentality he shares, and he knows he'll have to set the director straight. Please, come in. Good afternoon, Dr. Clark. Dr. Davis, thank you for coming to see

me. Please, please sit. Thank you. If I may, Dr. Clark, I'll get right into it. Yes, please. The findings concern me. Well, they concern me too into it. Yes, please. The findings concern me. Well, they concern me too. That's a lot of sick Negroes down there. That's not exactly what I mean. Obviously, there's an ongoing health crisis in Macon County, but I feel we need to be careful with how we reveal this data to the public. Clark plasters on the most patient grin he can muster.

Here it comes. Please, go on, sir. The impression would be given that syphilis in the South is a Negro problem, rather than one of both races. I fear this really unfortunate emphasis on the Negro, specifically, could rouse resentment among Negro groups in both Northern and Southern communities. 36% of Negroes in one impoverished county in Alabama, not reflective of the country's Negro population as a whole. I have no doubt the data is accurate,

but we both know that syphilis isn't just a black disease. The Rosenwald Fund wants no part of lending credence to that stereotype. Sure, certainly, certainly. And don't think I haven't thought of this. Now, I know how concerned you and the fund are with Negro progress, and it's very forward thinking. Very forward thinking. But, um, let me tell you, Doctor, Northern Negroes, the vast majority of them will not give this matter a second thought. And as far as the Southern Blacks are concerned, well, they all love the program.

I appreciate that, Dr. Clark, but still, many are bound to ask why Negroes only? Why not test Southern whites as well? We know they have the disease too. If we don't test them, we could be accused of bias. Bias? Well, I assure you bias has got nothing to do with it. I personally would have loved whites to be included in the testing and treatment. But I'll tell you, Dr. Davis, I know a thing or two about Southern whites. Take it from me, they would not be easy to deal with. Whereas Dr. Wenger assures me the Negroes down South are most cooperative. Do you take my meaning? It's a matter of cooperation and not of discrimination that the work is limited in Negroes. We'll just learn more this way.

And that's the truth, Dr. Clark. That is the truth. In fact, I believe we should give serious consideration to expanding the program. We've got a good thing going. Why slow it down? Well, all right then. I won't keep you, Dr. Clark. Clark smiles, stands, and shakes Davis' hand. Thank you, doctor. So I appreciate you coming in.

Once Davis is gone, Clark turns back to the data and starts forming plans for the next stage of the program. He wants it to expand and figures everything will be fine as long as Davis and his Rosenwald Fund don't get in the way. Davis and his Rosenwald Fund don't get in the way. The following year, Clark is in his office when he learns that the Rosenwald Fund has gotten in the way. For months, he lobbied the Fund to expand the Negro Syphilis Treatment Program. But today, he's received a letter from Dr. Davis.

The Fund has balked. Too expensive, especially during the Depression. Clark slams his fist on the desk and paces. Takes every ounce of restraint he has not to rip Davis's letter to pieces. He reads it over and over again, and it's more irritating each time. In his mind, he hears the words in a sniveling voice. The fund has regarded it as a privilege to be able to assist during this preliminary period of study and attack upon this great problem in southern rural areas. That's hogwash.

Clark thinks the fund could find the money if they really wanted to, but would rather back efforts to educate the Negro. They're not really concerned with his health, but Clark is. He thinks that the PHS should be building health clinics for black people, rather than wasting money on schools. Clark has his own pet name for what these schools might produce. White Collar Negroes. The world doesn't need white collar Negroes.

It needs Negroes who aren't contagious. Bitterly, Clark realizes it's time to write his final report on the Macon County syphilis treatment efforts. He sets Davis's letter aside. He's decided he's never going to look at it again. He closes the office door to shut out the noise of the hallway, loads a sheet of paper into his typewriter, sits down, and begins to rapidly punch the keys. But after about an hour of writing, he abruptly stops. How did he not think of this before? It was staring him in the face the

whole time, right here in the data. Macon County has the highest prevalence of syphilis in the South. Any of those infected received treatment, but many did not, because the Rosenwald funding dried up before anyone could tend to them. Clark wonders what would happen if the PHS decided to focus on the ones who weren't treated. What if they stayed that way? Could they be useful to understanding more about the disease? Clark has a feeling they could. Now, he's not a monster. Would he prefer to treat the syphilitic blacks?

Of course he would. But if the Rosenwald Fund won't pay for it, that means there's no money to treat those people. So it doesn't matter what he'd prefer. And if he can't treat them, he can do something almost as good. He can learn from them. What Clark's imagining is a sweeping experiment, unprecedented in its scope.

Doctors know that many black people suffer from syphilis. But do they really know the effects of the disease on blacks specifically? Many have theorized that syphilis affects blacks differently than it does whites. But no one's ever actually proved it. Clark feels that someone really should conduct that study, and that someone should be him. That's where he'll make his mark on medical science. Throughout 1932, Clark makes plans.

This is to be a serious study. A disciplined and absolute commitment to the scientific method will be required. The subject is untreated syphilis in Negroes. Clark is pleased to discover that the work is not without precedent. Just three years earlier, in Oslo, Norway, a Dr. Brusegard observed hundreds of local test subjects with primary and secondary syphilis. Examination only. No treatment. Brusegard wanted to study the nature of syphilis-induced cardiovascular and neurologic damage. As Clark reviews the details in a German scientific journal, he nods in satisfaction, a smile on his face.

Obviously, the study was whites only. It was conducted in Oslo, Norway, for God's sake. Obviously, the study was whites only. It was conducted in Oslo, Norway, for God's sake. Thus, it serves as the ideal template for Clark's counterpoint, a coloreds-only rendition. But Clark wants to do the Oslo scientists one better. They base their conclusions off case histories. They didn't conduct ongoing examinations.

So Clark will collect his data in real time. With his pitch assembled, Clark starts lobbying colleagues at the PHS. He invites them to meet him in his office, at his home, in the local restaurants most popular during lunch hour. He shares his ideas and is encouraged by the response. All agree that the study is worthwhile. Yes, there are risks to the infected, but those risks pale in comparison to the potential medical insights. One colleague who is fully on board with Clark's plans is Dr. Oliver C. Wenger. He happily agrees to collaborate with Clark once again. With Wenger's support secured, Clark knows it's time to get on a train for Alabama. Upon their arrival, he tells Wenger he must see the state health

officer, Dr. J.N. Baker, immediately. It's a pleasant September day in Montgomery when Baker opens his office door to admit Clark and Wenger. Baker sits down, then gestures for the men to proceed. He's aware that they have ambitious plans to study the Negroes in his state, but he needs to be certain these men know what they're talking about. The PHS doctors describe their intentions. Baker takes it in, nods. study the Negroes in his state, but he needs to be certain these men know what they're talking about. The PHS doctors describe their intentions. Baker takes it in, nods, asks for clarification. They seem like intelligent men. Clark promises to iron out certain details and even admits there are still many questions of procedure to be worked out. When Clark is done with his pitch,

Baker waits a long while before speaking. Drumming his fingers on the desk, he realizes he's thought of a couple of things they haven't. When he finally speaks, he agrees, but with some conditions. Yes, Clark can do his study, but observing blacks without offering any treatment whatsoever isn't going to work. To be perfectly clear, Baker explains, it's not that he has a problem with the potential impact on the test subjects. He's more concerned with their white employers. They may not be happy to learn of a program that isn't doing everything it can to keep their workers as healthy and productive as possible. Baker says at the very least,

Clark and Wenger's operation must take steps to render some of the blacks non-infectious, and this is non-negotiable. He asks Clark if they have a deal, and Clark says they do. When the study starts, minimal treatment will be provided. With that, Baker nods and shakes their hands. The visiting doctors move as though they're about to leave, but Baker stops them. He has one more condition. He tells them that if they're going to study untreated syphilis in Macon County blacks, they better find some local sponsors. He can't have the PHS running about Alabama and experimenting on the locals without the support of a trusted medical institution, preferably one that already employs

a number of black doctors and nurses. Clark nods rapidly in agreement. Baker can see the man filling in the blanks. There's really only one place in the country that meets those conditions, and luckily for Clark and Wenger, it happens to be just 15 minutes away from the heart of Macon County. From Montgomery, Clark and Wenger hit the road on their way to the illustrious Tuskegee Institute. Co-founded by Booker T. Washington, the Institute has stood since 1881 as one of the most significant bastions of Black education in the country, a place where Blacks can truly receive a world-class education in both the medical and industrial arts. They're planning to meet with Dr. Eugene H. Dibble, Tuskegee's medical director, and they're nervous.

They're about to tell this Black doctor that they intend to oversee an experiment on local syphilitic blacks. They will not tell the black test subjects that they have syphilis and will observe the disease as it runs its course, almost totally unimpeded by medical intervention. The experiment will be presented to test subjects as an extension of the Rosenwald Fund treatment program, but it isn't. The conversation is a minefield. They'll have to be cautious and nuanced in how they go about securing Dr. Dibble's support, because Tuskegee is the only place their experiment can be carried out.

Dr. Eugene Dibble makes sure he's standing straight when Clark and Wenger pull up. He hopes they'll be suitably impressed with John A. Andrew Memorial Hospital and with him. The hospital is a beautiful brick building with white trim and four magnificent columns at its center, and Dibble's worked hard these past seven years to ensure that it stands as a monument to Black achievement and prosperity. Every aspect of the Institute reinforces that serious and legitimate work is done here. Dibble recognizes that he must do all he can to propel Tuskegee into the future. It's nearly 1933, and if Black people are to progress in this country, they must not remain isolated. He's anticipating this meeting as much, if not more, than the white

doctors from the PHS, just now stepping out of their car. Hello, Dr. Clark, Dr. Wenger. I'm Eugene. Dibble notices as Clark shoots Wenger a quick look before taking the lead. Well, it is certainly an honor to meet you, Dr. Dibble. We have much to discuss, and preferably in private. Can you show us to your office? Of course. Once the three doctors sit down, Dr. Clark does most of the talking. Dibble is content to do most of

the listening. He can tell Clark is leaving details out, perhaps intentionally, perhaps not. This is all to be expected, however. Dibble reminds himself to maintain focus on one thing, the good of the Institute. This is a wonderful facility you have here. We want to help you make the most of it. Nothing will do that like you committing to help your government facilitate scientific progress. Wenger jumps in. You can bet that in Washington, you'll never forget your valuable service to your country and your people. Dr. Dibble, the work we'll do here, with your help if you let us, will truly improve public health on a national scale for generations.

Dibble remains silent for several moments, processing the information. He sees Clark and Wenger look at each other almost nervously. He realizes that they need him just as much as he needs them. Dibble is not used to this kind of power, but he likes it. Of course, he was always going to say yes. The prestige and association with the PHS will bring to Tuskegee is immeasurable. But they don't need to know that. Dibble puts on his best thoughtful expression and breaks the silence.

I believe I understand. You want the Institute to provide you with the interns and nurses you'd like to use our offices and examination rooms. And you will be providing some measure of treatment to Macon County Blacks with syphilis, though some of the details are still being worked out. The program will last the better part of a year, and you need me to sign off on all of this, or the program will not be able to go forward? Yes, Dr. Dibble, that is correct.

Well, doctors, you have my support. I think this study will be wonderful for the Tuskegee Institute. Our young nurses struggle to secure meaningful employment after we train them. Out in the world, white people will rarely agree to hire a black nurse. So if you're telling me you'll employ black nurses and black physicians for your study, then I think that's a good thing. That's the most important thing. Dibble notices Clark suppress a grin.

Oh, I agree, doctor. and you won't regret this. Now, if you allow Dr. Wenger and I some time to work out the protocol for our study, we'll return with some plans. Together, we'll propel this fine institution of yours to a level of respect and prestige it's never seen. Following a brief tour of Tuskegee's hospital, Dibble sees Clark and Wenger to their car. Smiling, he waves goodbye as they drive off, cloud of dust in their wake. As it settles, he pictures the years ahead and all the success to come. Great new chapter in the history of the Institute is about to begin, and Dibble is proud of his role in it. It is at this instant, however, that his smile fades. If he's being honest with himself,

he's not so sure that Booker T. Washington, where he's still alive, would be so proud. Dibble shakes the feeling off and returns to his office. Booker T. Washington isn't here. This is a different time. He was hip-hop's biggest mogul, the man who redefined fame, fortune, and the music industry. The first male rapper to be honored on the Hollywood Walk of Fame, Sean Diddy Cone. Diddy built an empire and lived a life most people only dream about.

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scientific protocol, he still has a lot to sort out. Which syphilitic blacks will be observed? He obviously can't include all of Macon County's infected 36%. How many test subjects does he need, and which ones should they be? He's hoping Moore and Keidel will contribute suggestions to flesh out the Tuskegee study so he can begin in earnest. As the doctors walk across the school's expansive campus on a crisp fall afternoon, Clark gets all the suggestions he could hope for, and more. Of the two Johns Hopkins doctors, Moore is the more talkative. He warns Clark of pitfalls to avoid.

First, this study can't be about black people. That doesn't mean examine people of other races, he says. It means examine black men only. Clark writes that down, but wants to know why. Moore replies that since female genitals are primarily inside the body, it's much harder to get reliable information as to the date of the syphilis infection. For a woman, early syphilis symptoms can easily be mistaken for something else. That makes sense to Clark.

He asks if there's anything else. And Moore says there is. Ideally, no men under 30. The younger the test subject, the more difficult it will be to observe the late-stage manifestations of the illness. Next, Moore suggests that the men be brought in batches to the Tuskegee Clinic and asked to provide a full and accurate medical history. Only men who can identify exactly when their infection took place should be allowed to participate in the study, as this will make Clark's job much easier. Additionally, Clark should seek a total of 200 to 300 patients.

Given Macon County's infection rates, it shouldn't be hard to find enough men who meet these criteria. Finally, Moore reminds Clark of something very important, something Clark already feels he knows, but to him, it's worth remembering. Moore tells him not to forget that syphilis in the Negro is in many respects almost a different disease from syphilis in the Negro is in many respects almost a different disease from syphilis in the white. Like Clark, Moore is eager to see how the data derived from the blacks

and Macon will compare with the data obtained from the whites in Oslo. Clark and Moore believe that whites and blacks are simply fundamentally biologically different. Like many American doctors, they cling to the theory that syphilis is likely to damage the neural systems more in whites and the cardiovascular system more in blacks. Clark hopes that his study, with its real-time examination of subjects, will prove this once and for all. For the past eight months, Eunice Rivers has been the supervisor of night nurses in Andrew Hospital at the Tuskegee Institute. As usual, she's feeling beat.

It will probably take another eight months before she's used to working all night, not able to head home until sunrise. But she'll get used to it. For as long as she can remember, she'd strive to make her father proud. Albert Rivers was a man so illiterate he could barely write his own name. Eunice can never forget how determined he was for his eldest daughter not to be like him. Eunice can never forget how determined he was for his eldest daughter not to be like him. He pushed her to pursue a rigorous education, sent her to a different town where his sister lived near a decent school where children could really learn something. Eunice came to appreciate the fact that her father would always quiz her on what she'd learned

the second she returned home after a full day of class. When she was college age, he enrolled her at the Tuskegee Institute with what little money he had. She took up handicrafts, but her father put a stop to that. He told her she had potential and could be a great nurse. Eunice proved her father right. She excelled, which is why Dr. Dibble promoted her to night manager. But when Dr. Dibble requested a meeting with her today, she got nervous. She's tired all the time now. She walks down the long stretch of hallway that ends at Dibble's office and wonders, did I make a mistake? Did I mix up the x-ray charts? Something else? She knows she should

have double-checked. Now she's probably about to get fired and right in the middle of what people are calling a Great Depression. Come in. You wanted to see me, Dr. Dibble? Yes, Nurse Rivers. Please sit down. Dr. Dibble seems happy, so Nurse Rivers relaxes. Maybe she was wrong. She relaxes more as Dibble begins to talk. He says he's always been an admirer of hers, respects her work ethic, her medical background, her way with patients. He mentions a Dr. Clark with the public health service, and then he comes to the point. So all that said, I have good news, Nurse Rivers. The PHS is going to do a study and has picked a skeegee to facilitate it. Well, that's so exciting, doctor. I'm happy to hear that. And I want you to help with the study. Rivers is taken aback. Well, how can I

help, doctor? Well, the study is going to examine men in our local community, black men specifically. The study will examine the effects of untreated syphilis in the negro male. You have a solid background in public health projects, so I'd like you to be the special scientific assistant for the study. Will you do it? Well, yes, of course, but what? Well, I just don't think I know syphilology in enough detail to be useful. It's really not enough to be anyone's special scientific assistant. You can do whatever they want done. I don't have to worry about that. Rivers smiles. If the medical director believes in her, she can believe in herself. She allows herself a laugh. Well, now, what's so funny, Nurse Rivers? Well, I have to be honest

with you, Doctor. I would have done almost anything to be off night duty. Yes, I can assure you this is much better than night duty. I can't wait for you to meet Dr. Clark. He's a good man. duty. And I can't wait for you to meet Dr. Clark. He's a good man. I think we can trust him. At that moment in 1932, Dr. Tolliver Clark is in his office quite pleased with the latest developments. His diligent work has helped him secure the backing of the Alabama State Board of Health, the Macon County Board of Health, and the Tuskegee Institute with all its Black personnel at his disposal. The Tuskegee study of untreated syphilis in the Negro male will last around six to eight months and begin in October, which is just a few short weeks away. Clark sorts through his mail and is glad to see a letter from his colleague, Dr. Wenger. He opens the letter up and beams as he

reads. In it, Wenger expresses his eagerness to begin, an eagerness Clark shares. Wenger ends his letter with, I am confident the results of this study, if anywhere near our expectation, will attract worldwide attention. It will either cover us with mud or glory when completed. Clark couldn't agree more. Next on American Scandal, the Tuskegee study of untreated syphilis in the Negro male officially begins and quickly becomes something darker and far from glorious. After the

selection of the test subjects, Dr. Clark reveals what he's truly after. But the black medical professionals of Tuskegee find they're in too deep to turn back. From Wondery, this is American Scandal. You've just finished episode one of the Tuskegee syphilis study, but the story is far from over. As the study progresses, government doctors continue to deceive hundreds of black men who believe they're receiving life-saving treatment for a condition known as bad blood, but in reality are subjects of a shocking experiment. As you delve deeper into the season, whistleblowers fight to expose the truth, but will it be enough to stop the government's decades-long cover-up? And as these men suffer in silence, you'll wonder if justice will ever

be served for these victims. To listen to the rest of this season of American Scandal, start your free trial of Wondery Plus in the Wondery app, Apple Podcasts, or Spotify. With Wondery Plus, you can listen to other incredible history podcasts like American History Tellers, History Daily, Tides of History, and more. Amazon Music listeners can still listen to the newest seasons of American Scandal ad-free on Amazon Music. Just a quick note about our reenactments. We can't always know exactly what was said,

but everything in our show is based on historical research. American Scandal is hosted, edited, and executive produced by me, Lindsey Graham, for Airship. Sound design by Derek Behrens. This episode is written by Hannibal Diaz. Editing by Casey Miner and Emma Cortland. Executive producers are Stephanie Jens, Jenny Lauer-Beckman,

and Hernán López for Wondery.