Review

Author(s): Nancy Kang

Review by: Nancy Kang
Source: African American Review, Vol. 44, No. 1/2 (Spring/Summer 2011), pp. 301-304
Published by: St. Louis University
Stable URL: http://www.jstor.org/stable/41328747
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was assumedto be a materialissue,and thissomewhatnaveconclusionis complicatedbythebook's relatively

thinsense of thewaysrace and materiality
functioned
- groundexploredby scholarslike
in thenineteenth-century
Americanlegal system
Paul Finkelman,ArielaGross,andJeannineMarieDeLombard. Smith-Pryor,
like
the
Lewis and Ardizzonebeforeher,is also too quickin consideringthehour after
moment.WhileRhinelanderdied onlya decade afterlosingthetrialandJones'slong
theseemingly
endlesslegalmaneuvers
laterlifeseemsto havebeen almosthermetic,
- such as Rhinelander's
afterthetrial
attemptsto obtainan "easy" Nevada divorce;
theeventsleadingto a setdementallowingthatdivorceto be finalized;Jones'ssuits
and threatsof suitsagainstRhinelander,
his father,
his father'sestate,and so forth,
- offerrichbut stilluntapped
in referenceto both thetrialand the setdement
and gender
potentialformoreextendedconversationabout race,class,property,
in thetwentieth-century
Americanlegal system.
The briefcomparisonbetweenProperty
Ritesand "Love
onTrialabove willlikelybe
in
not
one
of
that
readers
similarities
draw,
onlysubjectmatterand
only
many
given
basic argumentbut also coverageand gaps. TheywilllikelyfindthatSmith-Pryor's
book is more"academic":itswritingis a bit drier,its theoreticalargumentsa bit
But thesedifferences
are not nearlyas important
denser,and itsnotationmuchfuller.
Rites.Smith-Pryor's
account
as thosetiedto the sourcesand approachof Property
she located
relieson a muchricherarchivalbase thandoes LoveonTrial,specifically,
thefull"Cases and Points:Recordsand Briefs"of thetrial,whichoffersnot only
trialtranscripts,
but also textsof variousdocumentsfiledbyboth sides.WhereLove
onTrialreliesalmostcompletelyon thevoluminouspresscoverageof thetrial(and
readssuchskillfully),
Ritesplacesthatcoveragein dialoguewithtrialdocuments
Property
thusalso regularly
examinesdiscrepancies
and a host of othersources.Smith-Pryor
also
betweensources.As a formerattorney,
Smith-Pryor bringsa lawyer'ssensibility
- and so probes questionsof legal strategy
withacumen.
to herworkas a historian
Ritestowardemphasesand
One would expectthesequalitiesto lead Property
conclusionsdifferent
fromthosein LoveonTrial- and sometimestheydo. Property
Ritesoffersmuchmoredetail,forexample,on thewaysin whichlegal structures
shaped how thecase was, and could be, argued;thereare also severalmore subtle
in how theworkstreatrace,raciallabels,and passing.But one of the
differences
Ritesis its failureto pointout such differences
most frustrating
pieces of Property
Ardizzoneand Lewis each appearonlyonce in
and to engageLoveonTrialdirectly.
to onlya handfulof timesin
theindex,and theirbook is briefly
and obliquelyreferred
thetext.Property
Riteswould havebeen muchricherif Smith-Pryor
had moredirecdy
whather
insertedherselfinto a dialogue- if she had consciouslydemonstrated
sourcesand approachforcestudentsof theperiod,and readersof LoveonTrial,
to reconsiderand reevaluate.Withoutthatdialogue,readerswillstillwantto and
this
stillhaveto read both books and thinkhardabout thenextstepsin researching
web of events.
fascinating

Susan M. Reverby.ExaminingTuskegee:The Infamous Syphilis Study and Its

Legacy. Chapel Hill: U of NorthCarolina P, 2009. 384 pp. $30.00.
Reviewed by Nancy Kang, Clarkson University

blood" usuallyevokestheidea of hostilerelationsbetweengroupsor

distrust
Bad individuals,
an emotionalspectrumthatstretchesfromlingering
The
Yet as Susan M. Reverby'smasterful
to deep-seatedenmity.
Examining
Tuskegee:
reviews

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301

StudyandItsLegacy
Infamous
Syphilis
explains,thecatchphrasetookon othernuancesin
thecontextof AmericanpublichealthpolicyduringtheJimCrow era.As Reverby
thevenerealdisease
illustrates,
having"bad blood" was a euphemismforcarrying
also knownthroughout
itslong global presenceas "the pox," the"bad dissyphilis,
ease," and "lues venereal,"itsLatinname (23). Yet theequationof epithetand epidemicwas not alwaysclearand immediate,especiallyto some of theapproximately
600 AfricanAmericanmen (400 of whomhad thediseaseand 200 controlswho did
in the forty-year
not),all participants
TuskegeeSyphilisStudy(1932-72).The U. S.
ublicHealthService(PHS) commenceditsresearchin Tuskegee,theMacon County,
Alabama citymade famousbythelegacyof BookerT. Washington,
accommodationisteducatorand authorof thewell-knownautobiographyUpfromSlavery
(1901).
The studysoughtto examinetheeffectsof nontreatment
on late-stage,
latent(thus,
but did so withouttheethicaltransparency
noncontagious)syphilis,
expectedof
rural
male
not aware
were
today'smedicalresearchcommunity.
Tuskegee's
subjects
thattreatment
was beingdeliberately
withheld.Enticedbyphysiciansseekingwhat
wouldessentially
be informative
corpses,theywerepromisedmedications(a semblance
of treatment),
freemeals,transportation
to and fromtestingsites,burialinsurance
or assistance,and the satisfaction
of servingin an importantinitiative
aimedat the
that
This
was
a
led
to
carefully
misplaced
greatergood (79).
engineeredduping
and thegenesisof a complexand damaging
trust,possibleearlydeathand disability,
narrative
of stateabuse thatstillgripsthenation'sethicalimagination.
sectionswithalliteraReverby'stexthas threeself-contained
yetcomplementary
tivesub-headings.
Each explainsthecentralpreoccupationof thehistorianas an
excavatorof competingversionsof truths.Hearingtestimony
and traveling
are
, testifying,
all acts thattranscendanyparticularacademicspecialty,
so thescope of thetextis
establishedearlyon as broadlyinterdisciplinary.
Partone ("Testimony")offersa
detailedsummaryand analysisof thestudy'shistory,
beginningwithan overviewof
cultural
and
the
cruces
of
medicine,and race as they
morality,
syphilis'
significance
to
the
era's
health
pertained
public
segregation
apparatus.Parttwo ("Testifying")
focuseson thenotionof voice- who was silenced,who spoke up,whose stories
- whileoffering
wereheard,and whose deservemoreconcentratedregard
short
character
sketchesof blackhealthcarepersonnelintegralto thestudy.These included
Dr. Eugene H. Dibble of TuskegeeInstituteand publichealthnurseEunice Verdell
RiversLaurie,mostcommonlyknownas Nurse Rivers.Partthree("Traveling")is a
arbiters
meanderingforayintohow postwarAmericansocietyand itsimaginative
channeledtheirmoraloutrageintoart.Reverbyexplainshow thecreativeproducts,
'
amongthemDavid Feldshuh'splayMissEversBays,and itssubsequentmovieversion,
have not alwaysbeen historically
accurate;despitethis,theyserveas emotionally
fora morevigilantand historically
informedpublic.Also includedin
chargedcatalysts
thissectionare supportingchapterson HenryW. FosterJr.'sfailedbid forSurgeon
After
Generaland a dissectionof theofficialapologybytheClintonadministration.
them
a personally
inflected
the
author
includes
extensive
appendices,among
epilogue,
a compendiumof themajorfigures'names as well as a listof studyparticipants.
This latterinformation
was releasedpubliclyforthe firsttimein 1997. There are
thedatesof
also tablesand chartson probableoutcomesforuntreated
latentsyphilis,
and
the
men's
relative
at
the
start
of
the
recruitment,
study, autopsy
participant
ages
on thesubject,
statistics.
Whileit appearsthatthereis no dearthof information
Examining
Tuskegee
compelsus to thinkagain.
One abidingfeatureof Reverby'shistoricalassessmentis herattemptto unpack
deconstructassumptions,and grapplewiththeendemicuncertainties
motivations,
itselffromother
thatcharacterized
thestudyand itsaftermath.
The textdifferentiates
forescape,racial
meditations
on thesubjectbyfocusingon "contingencies,
possibility
thattheydid nothingwrong"(239).
and thewhysof thedoctorsthinking
assumptions,
As thenameimplies,thePublic Health Servicehad a pivotalrolein moldingmass
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disease,and treatment
options.By takinga critical
perceptionsabout prevention,
the
author
how the
of
the
PHS
and
to
the
highlights
Tuskegee,
goals
approach
An
both createdand reaffirmed
misconceptionsabout racialdifference.
department
of blackmales as vectorsof sexual,moral,and social
exampleis the stigmatization
degeneracy;theidea thatthisgroupposed a symbolic,if not literalthreatto white
healthfoundsubtlebut definiteexpressionin thestudy.Whilemeetingwithvigorous
denials,racewas a centralconsideration,
especiallythepervasivenotionof blacks'
to venerealdiseaseslike
"sanitarysins" (26) and hence theirparticularsusceptibility
in muchof the
"volunteers"
called
the
syphilis.Ironically, Tuskegeeparticipants
- wereconstruedas servinga greater
PHS rhetoricthatfollowedthemedia fallout
nationalgood bydonatingtheirbodies to science.
An endowedprofessorin theWomen'sand Gender studiesdepartmentat
on blackwomen's
Wellesley
College,Reverbyoffersan especiallyprobingcommentary
of theexperiment's
rolesduringthestudyperiod.Despite theandrocentrism
premise,
roundshad
notesthatthewomenwho weretestedin preliminary
Examining
Tuskegee
in purtwicetheamountof seropositivetestsas themen; theywerealso persistent
Mobe
available
examination
when
these
were
treatment
and
(43).
suing
physical
clinicsin Macon Countyhad twiceas manywomencome forwardforassistancethan
men (57). Clearlythispopulation,whilerelatively
uneducated,rural,and poor,was
abouthealthissues.Men and womenenthusiastically
neitherapatheticnoruninformed
even thoughthePHS, in itsunderlying
pursuedwhattheybelievedto be treatment,
irontonics,vitaminpacks,aspirin,
ended up offering
need to discouragetreatment,
and other"simpleelixirs"insteadof moreeffective
pharmaceuticals(55-57). After
it became increasingly
clearthatnot all the supposedly
the storybrokenationally,
werebeyondcontagion(97). This realizationhad seriousimplilate-stagesyphilitics
cationsfortheintimatepartners,
wives,and familiesof thetestsubjects,although
In the
thewomen'sstorieshave hardlybeen the focusof muchcriticalcommentary.
$10-millionsetdementthatwas reachedin 1974, each livingmale
approximately
subjectwithsyphilisreceived$37,500,whileheirsof deceased subjectswithsyphilis
received$15,000 (246). Parttwoincludesa more detailedconversationabout the
study'simpacton women and children,includingthe factthatno effortsweremade
its
to findand informnonspousalsex partners,althoughthegovernmentdid fulfill
to
immediate
members
to
medical
care
(131).
family
promise providelifelong
textis Nurse Rivers,hiredas an
presencein Reverby's
Perhapsthemostenigmatic
assistantand lateras a full-time
employeeof thePHS. The authoracknowledgesthe
haze of questionsthatsurroundedthis"privatepublichealthnurse,"someone who
would "care forthefamiliesand meetneeds" (72) whilesimultaneously
discouraging
treatment
as partof herprofessionalmandate(121). Riverscollectedand transmitted
data fortheresearchers,
a kindof humanumbilicusconnectingtestingagencywith
to themen as meredepersontestsubjects.Yet,as Reverbynotes,she neverreferred
and humanizingterm"patients"(52).
alized"subjects,"preferring
themoreprotective
black
The writerattemptsto understandthemoraldilemmaof the "hypervisible
butwithout
nursewhose caringappearedto have been deadly"(168). Sensitively,
sentimentalism,
Reverbygrappleswiththequestionof whetherRiverswas "eithera
or a powerlessnurse"(168). Publiclyhonoredforherservice,
middle-class
racetraitor
Rivers's achievements
wereremarkablegiventheracismand sexismthatpermeated
themedicalprofessionat thetime.Chapterninehas a strongdiscussionof Rivers's
withthemen,and herunderlying
quest to
background,heramicablerelationship
consent
securepermissionsforautopsies;theseformsendedup beingtheonlywritten
gatheredduringthe study(48). Less compellingin theanalysisof theRiversmythis
Reverby'sdeploymentof Linda Williams'sTom/Anti-Tomdialecticand how we can
view thewoman as eitheran "evil mulatto"alignedwithwhitedoctorsor a "tragic
mulatto,"morallylost because of hermisplacedloyalties.The relevanceof thisparticularcomparisonis questionablebecause Rivers'sstatusas a mixed-racepersonwas
definedRiversas black
unclear;Reverbyherselfmentionshow censusinformation
reviews

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303

in 1900,mulattoin 1910,and againblackin 1920 (169). Whateverhercomplexion

or blood quantum,she was stillconstruedas a non-threatening,
friendly
presence,
fromtheperceivedattitudesof thewhitephysicians.One wonders
quitedifferent
whetherthe same attitudeprevailedforElizabethKennebrew,her successorand
a potentialsourceof discussionin otherstudiesof thisnursingrole (103).
certainly
is richlyimmersedin theZeitgeistof twentieth-century
Examining
Tuskegee
AfricanAmericanlife(6). It divulgeshow theGreatMigrationcomplicatedattempts
at tracking
some of itsnow-mobilesubjects,especiallybecause of thepossibility
that
themen mightreceiveantibiotictreatments
whileunmonitoredbyPHS personnel.
This kindof logisticalconcernis juxtaposedwiththeinspiringstoryof theTuskegee
milestoneof theNurembergTrials,and theawakeningof
Airmen,thejurisprudential
thepublicto how unscrupulousstatescan takeadvantageof theirmorevulnerable
betweenNuremburgand Tuskegee,byReverby'sown
populations.The relationship
a "historicalfog"of facts,comparisons,and extrapis
a
one,
interpretation, slippery
olations(192). Readersmightbenefitfrommorediscussionon theconnections
betweentheNurembergCode on researchethicsand theU. S. treatment
of human
subjects,since"Americanresearchand Nazi murderwerenevermentionedin the
same breath;indeed,theywere setup as opposites" (66). Reverbyconscientiously
renderspolicydecisionsliketheKennedyHearings(whichled to theNational
ResearchAct of 1974), reiterating
how thestudy's"unclearcategoriesand uncertain
criterion
formuchof thediagnoses"(69) createddoubtsaboutitslegitimacy
forboth
international
and local observers(69). The textalso emphasizeshow thepostwar
discoveryof penicillinrevolutionizedsyphilistreatment,
makingwhistleblowers'
at confronting
thePHS and theCenterforDisease Control(CDC)
frustrated
attempts
evenmoredesperate,ironical,and tragic.
dismisses
Despite all its emphasison uncertainties,
Reverby'stextemphatically
thepopularand sensationalizedallegationthatPHS physiciansdeliberately
injected
stressesthehumandignityof the
subjectswiththedisease (201). She consistently
avoidswholesaledemonizationof the study'sproblematicarchitects,
and
survivors,
reflectsupon "how easilymedicaluncertainty
masksethicalblindness"(119). The
Epilogue broadensthe scope of inquirybydebatingthechoice of some ethiciststo
compareTuskegee'slegacywithAZT trialsbytheNationalInstituteof Healthand
theCDC in countrieslikeUganda. The anti-retroviral
drugsweremeantto prevent
mother-to-child
transmission
of HIV/ AIDS. She outlinesthebioethicsinvolvedon
a global scale,explaininghow theGlobal South and theAmericanSouth are not
that
and disparities
interchangeable,
especiallyin viewof thehistoricaldifferences
altertherespectivepopulations'access to medicalcare.Not everycountry,
theauthor
remindsus, can affordthesame structures
of oversightformalpracticeand accountUnitedStates.Indeed,itwas Reverby'sresearchforthis
abilityas thepresent-day
book thatunearthedtheGuatemalasyphilisexperiments
of 1946-48,a transnational,
U. S.-ledethicalbreachforwhichthefederalgovernment
formally
apologizedin 2010.
such
recent
discussions
of
and
race,
medicine,
Examining
Tuskegee
joins
history,
bioethicsas HarrietWashington's
MedicalApartheid:
TheDark History
ofMedical
onBlackAmericans
, winnerof the2007
Experimentation
fromColonialTimestothePresent
NationalBook CriticsCircleAward.Reverby'stextis strenuously
researchedand
but theyremainminor.
dulyaccessible.The readerfindsoccasionalinconveniences,
For instance,thelastentryin thephotographsection,thegravestoneof studyparticipantLucious Pollard,is a bitconfusingbecause we do not learnwho Pollardis
untiltheend of theepilogue.This storyis on thepenultimate
page of themain
discussionbeforetheauthorlaunchesintovoluminouspages of annotation.In many
ways,thereader'sjourneyfromdisorientated
ignoranceto eventualrecognitionis
symbolicof theethicaldilemmasposed bytheentireTuskegeeexperience.The
writerasks us to journeywithherto a tentative
end- a mossygravestonereading
"GONE BUT NOT FORGOTTEN"
but thereis no realsense of completion,
no easyrest.
304

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