1932.
32.3853° N, 85.6936° W

HERMAN SHAW
"They found penicillin. And they never gave it to us."

PRESIDENT CLINTON
"What was done cannot be undone. But we can end the silence."

HERMAN SHAW
"In my opinion, it is never too late to work to restore faith and trust."

Macon County, Alabama, lay in the band of dark, fertile soil that ran across the middle of the state, a region people called the Black Belt. Cotton was the cash crop that held the county together, and by the late 1920s most of the men who worked it owned nothing. They were sharecroppers. A sharecropper farmed a plot of land that belonged to someone else, gave the landowner a share of the harvest at the end of the season, and took home whatever remained. The houses where these families lived were wooden shacks supplied by the landowner. They had no running water and no indoor plumbing. More than eighty percent of the county's population was Black. The illiteracy rate was high. Most families had never been examined by a doctor. When the Depression arrived, the price of cotton fell through the floor, and the poverty that had always defined Macon County deepened into something closer to bare survival. The county seat was Tuskegee, home to the Tuskegee Institute and its teaching hospital, the John A. Andrew Memorial Hospital. The institute was one of the most prominent Black colleges in the country. The hospital was one of the few places in the region where a Black patient could be seen by a physician at all.

In 1929, the Julius Rosenwald Fund and the U.S. Public Health Service began surveying syphilis rates across six rural Southern counties. Macon County had the highest rate of all six. Roughly a third of the population was infected. The plan was to treat them. The Rosenwald Fund would pay for the treatment, the Public Health Service would administer it, and the results would show what could be done in a poor, isolated community. Then the Depression deepened. The Rosenwald Fund pulled its money. The treatment budget vanished. The survey data remained. What the Public Health Service still had was a large population of untreated syphilis cases in a county where no one could afford a doctor on his own, and the cooperation of the Tuskegee Institute, which had helped run the survey.

Dr. Taliaferro Clark, a senior officer in the Public Health Service and head of its Venereal Disease Division, proposed a different use for the situation. Instead of treating the men, the Service would observe them. The study would track the natural course of untreated syphilis in Black males over time. In 1932, working with the Tuskegee Institute and its hospital, the Public Health Service enrolled six hundred men from Macon County. Three hundred ninety-nine had latent syphilis. Two hundred one did not and served as controls. Most of them were sharecroppers. Dr. Eugene Dibble, the African American physician who headed the John A. Andrew Memorial Hospital, provided the examination rooms. None of the men was told he had syphilis. They were told they were receiving treatment for "bad blood," a local term that covered syphilis, anemia, and fatigue without distinguishing among them. They were promised free medical examinations, hot meals on clinic days, and burial insurance. For men who had never seen a doctor, the offer was difficult to refuse. The study was to last six months.

The procedures that kept the men returning year after year were designed by the on-site director, Raymond Vonderlehr. He needed them to submit to regular examinations that provided no treatment, and to painful spinal taps that were purely diagnostic. The letter sent to participants read "Last Chance for Special Free Treatment." The spinal taps were not treatment of any kind. Vonderlehr also required that each man's family agree to an autopsy after death as a condition of the burial insurance. The government would pay for the funeral, but only if it could open the body afterward. Nurse Eunice Rivers, an African American public health nurse who had trained at the Tuskegee Institute, was recruited as the link between the white researchers and the Black participants. She drove the men to their appointments, sat with them in the waiting rooms, remembered their names and their children's names, and kept them enrolled. She earned their trust over years. She would hold that role for the next four decades.

The first published report on the study appeared in the Journal of the American Medical Association in 1936. It described the purpose and the method in plain language. Subsequent papers followed every four to six years, in standard medical journals, available to any physician with a subscription. The study was not classified. It was not filed behind a military clearance or sealed in a government archive. It sat in the open literature of American medicine for decades, and no physician who read it raised a formal objection. No medical board questioned the design. No editorial board refused the paper. No one asked whether the men had been told what they actually had. The study ran on, through the war and after it, visible to every researcher who opened the right journal. It would be three decades before anyone inside the government questioned what was being done, and another six years after that before the public found out.

The military draft reached Macon County in 1941 and called up several of the study's participants. Standard Army intake included a physical examination. The Army's own doctors found syphilis, diagnosed it by name, and ordered the men to begin treatment at once. For the first time, physicians outside the study had examined these men and told them what they had. The Public Health Service intervened. It sent the local draft board a list of two hundred fifty-six names and instructed the board that these men were not to receive antisyphilitic treatment. The board complied. No one told the men why their orders had been revoked. They were returned to Macon County, untreated, and folded back into the study as though nothing had happened.

By 1947, penicillin had been proven as a reliable, inexpensive cure for syphilis. A course of injections could eliminate the disease in a matter of days. The cost was small. The federal government itself was funding rapid treatment centers across the South to eradicate syphilis county by county. Posters went up in churches and post offices. Mobile clinics opened in rural towns. When those campaigns reached Macon County, the study's researchers acted to keep their subjects out. Local Black physicians who might have treated the men had already been asked, years earlier, not to provide antisyphilitic care to anyone enrolled in the study. The men who had been promised free medical examinations fifteen years before now lived in a county where the government was curing syphilis in everyone except them. The cure existed. It was cheap. It was being administered in the same towns where these men lived and worked. They were not allowed to have it.

Year after year, the men came back, believing they were being cared for. Some found partial treatment on their own over the years that followed. A man might visit a doctor in another county or receive a shot at a clinic that did not know his name was on a list. By 1952, almost thirty percent of the syphilitic participants had received some penicillin from outside sources, but fewer than eight percent had gotten what could be considered an adequate dose. The rest received nothing at all. Through the 1950s and into the 1960s, the study continued on its annual schedule. Each year Nurse Rivers drove out to the farms and the shacks, collected the men, and brought them to the hospital. They gave blood. They submitted to examinations. The results went into files at the Public Health Service. No prescription followed. Men sickened. Men died. Wives were infected by husbands who did not know what they carried. Nineteen children were born with congenital syphilis. The papers kept appearing in medical journals, and no one stopped the study.

In 1965, a Public Health Service venereal disease investigator named Peter Buxtun, working out of San Francisco, learned the details of the study and wrote to the Centers for Disease Control raising ethical concerns. In 1969, the CDC formed a committee to review the matter. The committee examined the study's design and voted to continue it. Buxtun objected again. He was told the study would go on. He had left the Public Health Service in 1967 and enrolled in law school. Five years later, in 1972, he gave the study's records to Edith Lederer, who passed them to Jean Heller, a reporter at the Associated Press. Her story was published on July 25, 1972. It ran first in the Washington Star. The next morning it appeared on the front page of The New York Times.

The Department of Health, Education, and Welfare ordered the study terminated on November 16, 1972. By then, twenty-eight of the original participants had died directly of syphilis. One hundred more had died of related complications. Forty of their wives had been infected. Nineteen children had been born with congenital syphilis. Of the original three hundred ninety-nine syphilitic men, seventy-four were still alive. The study that was supposed to last six months had run for forty years.

An advisory panel appointed by the Department of Health, Education, and Welfare reviewed the study and found it "ethically unjustified." The panel stated that penicillin should have been provided to the men. No criminal charges were filed against any physician or scientist involved.

In early 1973, Senator Edward Kennedy held congressional hearings on human experimentation. Survivors Charlie Pollard and Herman Shaw testified. Civil rights attorney Fred D. Gray, practicing in Tuskegee, filed Pollard v. United States on behalf of the participants and their families. The case was settled for ten million dollars. Living syphilitic participants received $37,500 each. Heirs of deceased syphilitic participants received $15,000.

In 1974, Congress passed the National Research Act, requiring institutional review boards to approve all federally funded studies involving human subjects. The government also established the Tuskegee Health Benefit Program, providing lifetime medical care to surviving participants, and later their wives and children.

On May 16, 1997, President Clinton issued a formal apology at a White House ceremony. Eight survivors were still alive. Five of them attended. Herman Shaw, a cotton farmer who had been born in Tallapoosa County in 1902, stood at the podium and spoke.

In 1999, Tuskegee University opened the National Center for Bioethics in Research and Health Care on its campus. It occupies the same grounds where the men were once examined. Ernest Hendon, the last surviving participant, was still alive when it opened. He died five years later, at ninety-six.