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Tuskegee Syphilis Study - Treatment by Autopsy | 2

Tuskegee Syphilis Study - Treatment by Autopsy | 2

Tue, 18 Jun 2019 07:05

The Tuskegee Syphilis Study is underway, with hundreds of African-American men unknowingly serving as human guinea pigs. Though it's initially scheduled to last only a few months, the doctors in charge of the experiment land on a nefarious scheme to perpetuate the study indefinitely.

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A listener note. This series is about a shameful chapter in American history. As part of telling a 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. Charles Pollard isn't used to government doctors. He's not used to doctors period. No one here is. Black people in Macon County, Alabama, which is most people here, they just don't have the money. If you think you might die, we're sure you try and find a doctor. But short of that, you figure it out yourself. That's why today in late October 1932, Pollard is shocked by the sign he sees outside the schoolhouse not far from his family farm. The word suggests that times are changing that finally, maybe somewhere out there cares about what's going on in Macon. The sign reads, free blood test, free treatment by county health department and government doctors. You may feel well and still have bad blood. Come and bring all your family. Pollard is 26 and feels perfectly fine. But bad blood? He's never thought of that. What if there is something wrong? It's best to get checked out. So when he gets to the schoolhouse, he joins a line of local people already waiting. They're mostly men like him, farmers in their work shirts and overalls. Though there are a few women too. They file into the building one after the other. When it's Pollard's turn, the white doctor he meets is friendly enough, even asks if the needle is stuck in his arm for the blood test hurts. No, no, it feels fine. That's good, Mr. Pollard. Very good. Are you married? Sure, I'm married. Do you work? Of course I do. Got a farm where I live out in No, to Selga. Got some cattle, broke corn. You even got one of those mechanical cotton picking machines. We're probably the first all done. Thank you, Mr. Pollard. You can roll your sleep back down. Well, well, actually, doctor, I got a question for you. OK? While I was waiting, I saw a woman go in, bed back, coughed, couldn't make a move without it hurting. I saw her come out later and looked just bad as before. She said the doctor in there told her she was fine, not sick, just old. I see. So I guess I'm just wondering what kind of doctor's office this is. She didn't get no blood test. Ah, well, her doctor could probably tell that whatever that woman had, it wasn't bad luck. But what does that mean, though? Well, it can mean a lot of things, but mainly it means this. If we find out you have it, we've got to bring you in. You'll be notified by mail. Have a nice day, Mr. Pollard. Pollard rises and says goodbye. He's got a funny feeling, and it lingers as he heads back home. Bad blood. The doctor didn't exactly answer his question. But maybe that's just how doctors are. They know a lot of things that other people don't. That's just to trust them. Charles Pollard doesn't know that the government doctors aren't here to treat anyone. They're here hunting for test subjects, black men like him. In a few days, the government doctor will contact him and tell him to come back to the clinic. Pollard's tested positive for bad blood. He will be 40 years before he finds out he was lied to. 40 years before he learns that he really was sick. But no one tried to cure him. American scandal is sponsored by the new ABC drama Alaska Daily. When an indigenous woman goes missing in Alaska, it sparks new questions about other missing and murdered indigenous women. And that's where the thrilling new ABC drama Alaska Daily begins, and where it's headed will have you on the edge of your seat. Two time Academy Award winner Hillary Swank stars as Eileen, a veteran reporter who joins a team of local journalists working to bring the truth to light. From Academy Award winning screenwriter Tom McCarthy, Alaska Daily premieres Thursday, October 6th on ABC, and streams next day on Hulu. If you're into true crime, the Generation Y podcast is essential listening. We started this podcast over 10 years ago to dissect some of the craziest and most notable murders, crimes, and conspiracy theories together, and we'd love for you to join us. Follow the Generation Y podcast on Amazon Music or wherever you listen to podcasts. From wondering, I'm Lindsey Graham and this is American scandal. The Tuskegee study of untreated civilists in the Negro male began in 1932. Charles Pollard was one of 623 test subjects who would become unwittingly enrolled with no idea they were being used. Ironically the study had grown out of a real treatment program, but by 1932 the doctor's objectives had changed. They were curious to see what happened when the potentially deadly disease ran its full course and eager to document the unique ways it would ravage the black male body. And so they let the studies test subjects go untreated, seeing their suffering and eventual deaths as necessary sacrifices on the march towards scientific progress. This is episode 2, Treatment by autopsy. It's early November 1932 and it's pouring outside. Dr. Raymond Vondelair can't stand this weather. In his lab at the Tuskegee Institute, he stares at the neatly sorted vials of black men's blood and realizes he has a problem. When Dr. Oliver C. Wenger opened the treatment in diagnostic centers last month, the blacks came, hundreds of them, from shorter, harrowy, no to solga. Vondelair had been impressed. Wenger clearly knew what he was doing. When the men came, he and the other doctors listened patiently as they described their ailments. They gave advice and medicine where they could, but their main goal was to identify men with syphilis who were at least 25 years old. Wenger had told Vondelair that they'd lowered the age from 30 because the pool of subjects was so much bigger. Once they had their men, they hired Vondelair to run the field study of the untreated disease. When he first got the call, Vondelair was elated. He felt like his whole career had been leading to this moment. He's a graduate of the University of Virginia School of Medicine, in a native of that state, and he's been with a Ph.S. for seven years. Dr. Tulliver Clark and Dr. Wenger picked him because he'd taught syphilology at the medical college of Virginia. Plus, he'd study cardiovascular syphilis under some of the finest instructors in Europe. Dr. Wengerair knows this made him the perfect candidate. Dr. Clark is extremely curious to learn more about how the late stage symptoms affect Negroes, and Vondelair shares his curiosity. But if the blacks won't cooperate, then Vondelair and Clark don't have a study. This is what hasn't worried now. As he sits in his lab with that damnable rain threatening to cave in the roof, he begins a letter to his boss. He tells Clark that he now has samples from 300 patients, and that's a good start. And Vondelair adds, we are now wondering what will happen next when we try to get the Negroes in for study at the Institute Hospital. Days later, he receives Dr. Clark's reply. He seems just as nervous, telling Vondelair he's also worried that the men won't agree to physicals. But amazingly, they do. None of the local tests subjects see anything wrong with being physically examined. They seem excited even, pleased to be getting medical attention. Vondelair, a lifetime southerner, could kick himself for wasting all that time worrying. He should have known better. These people understand who's in charge. After the initial blood test, Vondelair brings in the positives for a second test just to confirm. After that, he whittles the pool down further, excluding any man who's been infected for less than five years, or treated for syphilis in the past. It's easy to find the people he wants. Something of friendly, young black nurse like Eunice Rivers doesn't hurt. Vondelair has her working 14 hours a day. When she's not driving the potential test subjects to and from the hospital, she's helping with the physical exams, boiling and washing syringes, making sure all the supplies are in order. Vondelair is greatly appreciative and so is Charles Pollard. Pollard's day starts early with a drive from his farm to the Tuskegee Institute. And to Ruff Ride. This river's coop doesn't have rumble seats and the rain has made Macon County's dirt roads money and hard to maneuver. But even though Pollard's nearly sick to a stomach from the ride, now that he's in the Tuskegee waiting room, he's starting to feel better about this treatment program. He and Nurse Rivers had a lot of time to chat, and she's assured him that the white government doctors are here to help. Any question at all, he can ask her. Pollard likes that. She brings over a smiling white man in lab coat. This must be the doctor. He reaches out to shake Pollard's hand. Good morning, Mr. Pollard. I'm Dr. Vondelair. If you follow me, please. We'll get your examination underway. So feeling okay, Mr. Pollard? I'm feeling fine. Thank you. Well, that's great. Well, I suppose we should get started. Nurse Rivers nods to the doctor and quietly shuts the door on her way out of the examination room. Now, Mr. Pollard, I don't want you to worry about the diagnosis. Just be glad we caught it in time. It never felt like anything was wrong with me. Of course, I see what I've got down there, but it doesn't bother me now. Totally understandable, Mr. Pollard. Totally understandable. Now, if you remove your pants and underwear, please. Yes, yes. How long have you had these sores? Five or six years, I'd say. Vondelair jotts down some notes. When he doesn't say anything more, Pollard asks the obvious question. Like I said, doctor, the sores never bothered me. Do you know what they are? Do I need medicine? The doctor places his pen down on his note pad, looks up slowly at Pollard and smiles. No medicine needed, Mr. Pollard. Charlie, please. Charlie, I don't want you to be concerned. Your lesions, they're nothing more than a complication of bad blood. Pollard is relieved, but there's still something bothering him. And what is bad blood? No one here's told me. Well, it's too complicated to explain, really. You're better off not worrying about such things. But the important thing is you're here. And from now on, we'll take care of you. We'll just keep an eye on that bad blood of yours. You'll do what we can to help. Vondelair beams at him. Charlie, do you understand how lucky you are? Lucky? Yes. You and your friends here. You're some of the luckiest Negroes in America. In the coming days, Vondelair starts feeling decidedly unlucky, though. Just over 400 men had been selected for the program so far, but analysis of their blood has led to disheartening results. He'd hoped to find parisis, the stage where syphilis affects the brain, leading to madness and paralysis. None of these blacks are showing the obvious signs. It's very disappointing. He's never had the chance to watch parisis develop and has been looking forward to it, wanted to record the effects. Now it looks like he may not get the chance, which is a shame, really. Worried he once again sits down in his lab and writes Dr. Clark. I'm aware of the great difficulty offered in recognizing the early subjective symptoms of parisis in the Negro, but it seemed unusual that I have failed to recognize a single early case of parisis with subjective symptoms in the 200 odd cases examined. Dr. Clark's response arrives the following week and lifts Vondelair's spirit somewhat. He tells Vondelair not to blame himself, it's to be expected. After all, the test subjects are low class blacks, so it will be harder to distinguish between madness and simple ignorance. Clark writes, I quite agree with you as to the hopelessness of recognizing mild parisis among these illiterate people of such circumscribed cultural horizon. I am hopeful that the spinal fluid examinations may throw some light on this question. The following day Dr. Vondelair makes an announcement to his staff at the Tiskihi Institute. They are going to begin doing spinal fluid examinations, also known as Lumbar Punctures or Spinal Taps. The staff murmurs in surprise. Vondelair had hoped to delay this procedure until 6 to 8 months from now when the project is scheduled to wrap up, but the search for parisis demands the work begin now. Spinal fluid analysis will do what clinical observation cannot and reveal what's truly going on inside the brain. He tells his staff it will likely be unpleasant work, for them and certainly for the patients. Seeing he has their attention, Vondelair goes into detail. He reminds them that having fluid drawn from one spine is extremely painful no matter how careful the doctor is and the doctor must always be careful. If the needle is inserted even slightly off the mark, the patient may suffer permanent paralysis. Even if no mistake is made, a large number of patients will likely report intense headaches, coupled with stiffness or numbness in the neck, arms and legs following the procedure. Our goal is to avoid the worst case scenario Vondelair tells the staff, these men must not be permanently damaged. These men are all volunteers and must remain volunteers Vondelair thinks. They need to be confident that the doctors are doing all they can to cure them of bad blood, confident and cooperative. If someone ends up crippled or in debilitating pain for weeks, word will spread and the test subjects will withdraw. It's a dilemma, but Vondelair has found a way around it. The solution is to lie to the men about the risks and crosses fingers that none of them suffer serious injury. Individual patients will be told they're coming in for an examination. Once they're in the door, they'll be told they're getting a spinal shot, not a lumbar puncture or a spinal tap, but a simple therapeutic shot. As proud of the phrasing, the men are already used to getting shots to make their bad blood better, so news of another one shouldn't scare them. He's also decided that after the puncture, they'll remain it to ski over night so the doctors can watch for negative side effects. Vondelair tells his team that they'll be performing 20 spinal taps every day. In another letter, Vondelair is completely honest with Dr. Clark about the risk he's taking. When Clark replies, he isn't the least bit concerned, it doesn't think the test subjects will cause any trouble. As he puts it, these Negroes are very ignorant and easily influenced by things that would be of minor significance in a more intelligent group. So with the blessing of his superiors, Vondelair composes another letter, this time to his test subjects. He makes sure the document looks as official as a piece of paper possibly can, listing out every organization that's signed onto the project. The letter had reads, Makein County Health Department, Alabama State Board of Health, and U.S. Public Health Service cooperating with Tuskegee Institute. Beneath that, Vondelair writes, Do your sir, sometime ago you were given a thorough examination and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examination. This examination is a very special one and after it's finished, you will be given a special treatment if it is believed you are in a condition to stand it. When he's finished typing, Vondelair grins, rather pleased with himself. With talk of special treatments, very special examinations and last chances, it's quite the sales pitch and it works. Scores of study patients enthusiastically embrace the opportunity to submit to a painful and risky procedure they don't know is coming. In May of 1933, at the Tuskegee Institute's Andrew Hospital, the spinal taps begin. What if your family was the victim of a home invasion, or you woke up in the morgue, or you were seriously injured, miles from help? What would you do? This is actually happening, asks our listeners this very question, while we bring you captivating real life stories of trauma and perseverance. This is actually happening, brings listeners extraordinary true stories from the people who lived them. You'll hear stories about conflict, turmoil, or threats that dramatically alter the course of someone's life. Each episode is an exploration of the human spirit and how survivors manage to overcome hardship and move on with their lives, even thriving afterward. The new season of this is actually happening is available ad free only with Wondry Plus, and if this new season isn't enough, you can listen to more than 120 exclusive episodes available only to Wondry Plus subscribers. Join Wondry Plus on Apple Podcasts or on the Wondry app. Nurse Rivers grips the steering wheel tight. When she breaks or accelerates, she tries to be as gentle as possible. She's doing her best, but knows her best is not good enough for Carter Howard. It's not his fault. He's just had the needle. Slow down. Slow down. Don't drive so fast. God, he's hurt. Hang on, Mr. Carter, almost home. I can't handle this Nurse Rivers. I can't. Yes, you can. You'll feel better soon. God, damn, is it supposed to hurt this much? I promise what you're feeling right now is perfectly normal. This isn't the first time Nurse Rivers has lied to a test subject. And it certainly won't be the last. But truthfully, she's surprised Howard isn't in more pain. She was there for his spinal tap, and it was awful. The doctor stuck him two or three times before he got it right, and each time Howard cried out in pain. All these spinal taps have been hell on them in. She drives them home as carefully as she can, but there's only so much she can do with her shabby car on these rocky dirt roads. God, it knocked me out Nurse Rivers. I fainted in there. I fainted, you know. She does know. You just lie down when you get home and rest. You hear? Just give it a few days. I'm telling you Nurse Rivers. If they're going to stick you in the back every time we go in there, I don't want to be there. That's the only time, Mr. Howard. You are all done. All right. We're here. You wait just a minute, Mr. Howard. I'll come around to help you through your front door. Nurse Rivers leaves Howard grimacing on his couch, cursing the government doctors. As she drives back to the hospital, she thinks about how he's not the only one she's left like that. Nearly every man who underwent a lumbar puncture emerged worse for the wear, many vowing never to return, even though she swore to them that the spinal shots are a one time thing. It's a serious problem. When she gets back to Tuskegee, she personally approaches Dr. Vondelaire and informs him that three of the test subjects refuse to come in. Others have offered various excuses. She does everything she can to change her mind, but they're too afraid. Vondelaire is prepping from the next spinal tap as they talk, and she can see he's not worried. He tells her she shouldn't be either. Are some of the men going to drop out sure? But that always happens in any kind of study where human test subjects are involved. What's important is the staff have performed 307 spinal punctures in just a few weeks. Dr. Wenger has said he considers this a remarkable showing. Nurse Rivers finds herself nodding along. Then Vondelaire tells her to get back to work, and she does. What else could she do? Nurse's shouldn't question doctors. Women shouldn't question men. And blacks shouldn't question whites. It's June 1933, and after nine months, it's finally time for the Tuskegee syphilis study to conclude. The final spinal tap is conducted, and Vondelaire starts saying his goodbyes. He bids farewell to the Tuskegee physicians who return to their regular posts. He thanks Nurse Rivers for her help, and wishes her well and pursuit of her next job. This experiment has been such an adventure of Vondelaire thinks to himself as he closes up the clinic. Feeling much like a small child ordered to put away his toys, he realizes he isn't ready for the fun to end, but... Huh? Nothing to be done. He returns to DC to the PHS building, and walks down the long hallway to Dr. Clark's office for a debrief. He expects all the regular things one expects from these meetings. Good work, Raymond. We're proud of you, Raymond. What's next for you, Raymond? But instead, Vondelaire sits down opposite Dr. Clark, and hear some surprising news. Clark has decided to retire. The PHS needs a new director of the division of venereal diseases, and the PHS and Dr. Clark already know who they would like to take over. In an instant, Vondelaire accepts. He immediately sees the potential for new research, the opportunity to explore fresh scientific frontiers, and above all, the power to decide the fate of the Tuskegee Siflus study. Why does it have to end now? Just when he and his co workers are on the cusp of genuine insight into the impact of untreated syphilis on Negroes, why does the study have to end at all? Under director Vondelaire, it doesn't. Vondelaire says all of this out loud. A tone of fervor begins to rise in his voice. True, the test subjects don't know they have syphilis. Yes, they were manipulated into getting their spines punctured. Maybe some people would question the tactics, but what they're too shortcited to grasp is that actually Vondelaire is a friend to the Negro. He's found some truly serious late stage pathologies in many of the test subjects. If he can demonstrate just how bad untreated syphilis can be for a black man, then perhaps Congress will take the disease more seriously and fund more treatment programs and facilities. Dr. Clark, he says, we would be medical pioneers. Meanwhile, Dr. Oliver Wanger is happily back at home. The place he considers his true home, that is, the venereal disease clinic he built in hot springs, Arkansas. In the clinic today, he makes his daily rounds. He examines new patients, warmly greeting old ones. He realizes that he honestly missed them. After Tuskegee, he's more passionate about helping Negroes than ever. It's a wonderful time to be a Negro after all. In the past, no one gave a damn about their health. Nowadays, they have doctors like himself and Dr. Raymond Vondelaire to look after them. In a cheerful mood, he passes by his secretary and asks if the day's mail has come in. Smiling, she hints it over. I'll be in my office for the next 15 minutes or so, he says. And once at his desk, he sits down and sorts through the many envelopes. One return address stands out. Dr. Raymond Vondelaire, public health service director of the Division of Venerable Diseases, Washington, DC. Banger reaches for the letter opener and begins to read. After a few lines, he grins. Ray is barely held the office a month, but he's wasting no time. Vondelaire has been corresponding with various health officers and reviewed all relevant syphilist related literature. He's come to a definitive conclusion that will transform the Tuskegee study for the better and forever. Venerable rare confidently states, everyone has agreed that the proper procedure is the continuance of the observation of the Negro men used in the study with the idea of eventually bringing them to autopsy. Wenger can't believe it. Not only does the study live, but Dr. Vondelaire wants to continue it until the test subjects die. Wenger nods. Such a long term longitudinal study would be groundbreaking and immeasurably further medical science. Vondelaire is made by doctors looking at Xrays will never match the observation's pathologist can make, looking at damaged organs under a microscope. There's just no substitute for the real thing. And as always, Vondelaire has already anticipated the objections. Wenger did think to himself if the men are to be observed until the end of their lives, and when does the study actually end? But Vondelaire has an answer ready. Autopsies may be, quote, impractical in connection with some of the younger cases, but he goes on, those more advanced in age with serious complications of the vital organs should have to be followed only for a period of a few years. Inspired, Wenger turns to his typewriter and begins to draft his reply. Naturally, there's the question of how the black men in Macon County might feel about all of this. Wenger supplies a simple answer. Fall back on the tried and true strategy and keep the patients in the dark. Most of these people won't like the idea of autopsies, carving up the body after death and stitching it back together won't sit right with them. These are simple, Christian folk, after all. So Wenger writes, just don't tell them. He adds, if the colored population become aware that accepting free hospital care means a post mortem, every dark he will leave Macon County and it will hurt Dibble's hospital. This can be prevented if the doctors of Macon County are brought into our own confidence and requested to be very careful not to let the objectives of the plan be known. He suggests that they make sure all the counties private doctors know that if someone dies in their care, their body should be turned over directly to the PHS for autopsie. Wenger takes note of Wenger's other ideas. Not all of them are correct and here Wenger knows he can be of help. His suggestions made he finishes up his letter, signs it, and hands it to his secretary for her to send by the end of the day. Wenger and his brand new DC office is a late to define that Wenger clearly shares his sense of urgency. Less than a week has gone by and already has an envelope from Hot Springs. This must be Wenger's response to the news that the study is alive and well. Von the Lair tears it open and is relieved to find that Wenger completely agrees with bringing the men to autopsie. He does take issue however with the continued employment of nurse rivers. She's not a bad nurse in Wenger's opinion, but Wenger notes, she's too soft with the men. But I don't see that she can do anything else than use up gasoline making weekly calls on these patients which do not seem to me to be necessary. Though they may be friends to their neighbors, husbands to their wives and fathers to their sons to the medical staff, the men in the study are none of these things. They are test subjects. Wenger puts it like this. As I see it, we have no further interest in these patients until they die. Von the Lair thinks it over. Wenger is saying the test subjects don't need a colored nurse babying them, but he disagrees. In his reply, he tells Wenger, unless someone is working locally with the idea of constantly keeping the welfare of the study in mind, very little would be accomplished. And so, nurse rivers will stay. Von the Lair does take one of Wenger's other suggestions. Wenger wants the black pathologist with the US Veterans Bureau Hospital, Dr. Jerome J. Peters to handle autopsies. They've worked closely with Peters already. He did many of the spinal taps. It's a good idea, Von the Lair thinks. The more black doctors and nurses are a part of this thing, the better. Dr. Eugene Dibble's mind races as he listens to Dr. Von the Lair share his updated plans for the syphilis experiment. Von the Lair smiles too much, talks too quickly, and of course uses all the right words. Dibble appreciates the effort, though inwardly, he chuckles a bit. Might men often get like this on the rare occasion when they need to ask a negro for something, just can't order him to do it. After a few moments, Dibble asks for clarification on one key point. So if I understand correctly, Dr. Von the Lair, this study is now to last indefinitely. Well, I don't know that I'd use that word specifically. I prefer to use the term open ended. Will the experiment end of course it will, but why end it prematurely? Well, we've truly learned everything there is to learn. To Dibble, this sounds perfectly reasonable, but for some of the test subjects he sees every day, it does sound like a death sentence. But if such a cost is going to be paid, then he'll at least ensure it's a cost beneficial to Tuskegee in long run. If the new aim of this study is to bring the patients to autopsy, that means you'll want to use Tuskegee facilities, nurses, and interns for the duration. That is correct. And we've already secured the funding. And you'll have reliable people performing the autopsies. Autopsies will be handled personally by Dr. Peters and yourself, sir, if you're open to it. Nurse Rivers will be on hand. This would be a very valuable education for her as I'm sure you're aware. This police is Dr. Dibble. It's exactly what he wanted to hear. I am aware. And I look forward to the continuation of our partnership. As do I, Dr. Dibble. This is truly historic making work we're doing. A rich study of the effects of syphilis on the human economy. Dr. Dibble has a stifle scoff, the human economy. He's certain that when Von DeLair discusses this study with his fellow white doctors, it's Negro male this and Negro male that, not so much when he's forced to discuss it with an actual Negro male. But Dibble thinks the semantics have some value. No one can accuse him of knowingly collaborating on a study potentially harmful to blacks. Besides what he does, he does for the good of his organization and the good of all his people. Yes, Dr. Von DeLair. This will be a rich study of the effects of syphilis on the human economy. Indeed. In the months to come, the doctor cement plans for the study's next phase. Not only will the men be brought to Autopsy, but there will be more men. A control group. In late July 1933, Dibble receives a letter from Von DeLair informing him the study should add, quote, on number of control cases having no evidence of syphilis. Dibble pauses to take that in. It means roughly 300 new test subjects. Von DeLair writes that adding the control group will clarify the disease's effects on the body. Those black men with syphilis can now be compared directly to those without under similar clinical conditions. Of course, they too will be deceived as to the true nature of the study. Dibble size begins composing a reply, agreeing to the proposal. There's a little else for him to do. In November 1933, Von DeLair takes note of the fact that he has the full and enthusiastic cooperation of both the PHS and the Tuskegee Institute to continue the study. Now he has to get all the local medical society and board of health supervisors in and around making county on board. These organizations will be useful in keeping track of who dies. DeLair wants to make sure he knows about every single test subject death to miss one would be disastrous. For the men must be promptly brought to Autosie. He decides he must rapidly schedule joint medical society and board of health meetings in each relevant Alabama county. He tells the officials he'll personally attend each meeting and explain the study in detail. For the next several weeks, he drives from county to county. At meeting after meeting, he's delighted to hear no objections. Instead everyone agrees that this study is valuable and beneficial to the entire field of syphilis research. Von DeLair is delighted and returns to DC eagerly awaiting the influx of data surely about to come his way. And he doesn't have to wait long. The first man dies within weeks. The Autopsies are hard on nurse rivers. For so long work had been a joy. Now just scares her. She doesn't like watching the doctors take soles to the men's bodies. She can't help but view the procedures as a regular person might. With horror. She reminds herself that she must be better than this. She's not a regular person. She's a nurse of the Tuskegee Institute, working on a pioneering study. Not long ago, Dr. Von DeLair told her that this experiment is very similar to one that was conducted in Norway on white men. This is simply the Negro version, he said. And it's very important. Doctors want to reflect well on the nurse's training program that made her. On Dr. Dibble, who has given her so much. If not for her position, she would be out there struggling like so many other poor souls. Desperate for employment and a great depression that shows no sign of ending. Rivers reminds herself that Autopsies may be crude, but she can't hide from them. She remembers her father, tries to think of what he might say if he were here now. For the first time in weeks, she feels strong. Dr. Dibble is calling, she can hear him down the hall. It must be time for her to help with another Autopsie. Nurse River stiffens, but this time, I've courage, not fear. She's doing meaningful work here in her patient's trust her. She'll just have to get used to seeing them cut apart. It's 1935, two years since the Autopsies began. And Nurse Rivers is surprised by how far she's come. Before, she could only think of the fact that men she'd talked with helped, comforted, and driven to and from their homes were now cold, lying on even colder slabs. From there, systematically sliced and disassembled. Their brains, vital organs, and spinal cords were moved and assessed. She was squeamish then, but not anymore. Now she's a true professional. Besides, Autopsies can only take place if the dead men's family's consent. It's her responsibility to secure that consent. A test object died today. His next of kin, expect her in the hospital waiting room any minute. It's tastefully furnished, but quiet and sterile. In a place where you feel you want to whisper even though there's no need. This is not Nurse Rivers's favorite room in the hospital, but she has a job to do. As she approaches, Rivers can hear a woman wail with grief. She enters the waiting room and sees the woman, the man's wife sobbing. She stands with tissues in hand, staring at the floor. Ma'm, may I sit with you for a moment. I'd like to speak to you about your husband. Her sits, pauses a moment in respectful silence, and begins. She can tell this woman will not be easy to convince, so she takes it slow. Your husband was, well, he was a great man. A great man. I'm so sorry for your loss. I just don't understand what happened. We saw he was sick. We just thought he'd get better. Then he didn't. Now I don't know what we're going to do. Nurse places her hand over the grieving woman. Let's her cry. Then the woman looks up at Rivers again. Ask her a question. Well, the same thing happened to me to us. Could we get what he got? Nurse Rivers can't help it. She begins to cry too. She honestly hopes her next statement isn't a lie. No, no, you're fine. I don't want you to worry. You won't get sick. Then she wipes the tears away like a professional would. Now, I want to ask you a favor. You don't have to do it. We don't have to do it. But I want to ask. Do what? The doctors want to learn what caused your husband's death. You know what an operation is. Yes? This is just like an operation except the person is dead. You open him up. No, no, no. But the funeral. I can't let anyone see him like that, Nurse Rivers. I can't. I can't. I won't be like that. During the operation, they'll just take a quick look in his chest, his stomach, and his head. When he's dressing in the casket, no one will even be able to tell that he had an operation. The clothes won't cover his head though. That's okay too. Can I describe for you how it works? They make an incision. It's like a small cut in the back of the skull. They pull the hair over the face. And then when they're done, they put the hair back in place, very, very carefully. In the coffin, he'll be on his back. He'll be lying on the incision. Understand? I've seen a lot of these and I won't let anything happen to him. After the operation, the doctors will have peace of mind. And so will you. What do you say? Well, okay, Nurse Rivers. You tell them that they can do it. Thank you. Nurse puts her arm around the woman. She holds her for a long time. It's a gesture she'll repeat often, as the study continues for the next 10 years. Dr. John R. Heller recognizes that 1943 is a landmark year in the history of syphilology. This is the year that science has finally found a reliable answer to the disease. Penicillin cures it. Heller is the inspired and energetic new director of the Division of Venerial Diseases at the PHS. He's proud to have inherited the position from Dr. Von DeLair, whose decided it was time to retire. Von DeLair was ready to bring his career to an end, but he made it clear before he left that ending the Tuskegee study was out of the question. Also out of the question, Heller knows, is curing any of the study patients. There will be no discussion of penicillin, and it will not be administered to any of the disease blacked. As Heller redecorates Von DeLair's former office, he's quite relieved that no one has debated or questioned the penicillin decision. Because it's obvious why it's a good choice. Everyone understands that if the test subjects are given penicillin, they'll no longer have syphilis, and if they no longer have syphilis, then the disease can't be observed as it takes over their bodies. All this work will have been for nothing. Heller personally hopes that the study will continue into the next decade, and under his leadership, it does. By 1951, the study is nearly 20 years old. There's a new Ph.S. director, and under him, Dr. Cineo Lansky and Stanley Schuman. A Lansky and Schuman operate out of the Ph.S. Veneriel Disease Research Laboratory in Atlanta. They're charged with conducting a full scale review of the Tuskegee experiment. Schuman is Lansky's assistant, and he's very busy lately. He can't believe how many meetings he has to attend every day. A highly detailed, oriented man, Schuman has personally been responsible for helping attract down the Ph.S. officials who got the study off the ground back in 32. He relished the task, and kept his fingers crossed the old guard still believed as much in the study today as they did back then. He was thrilled when they still backed it to the last man. With the founding father support, he and Lansky collected documents and data to undertake a full scale review of the experiment's procedures. Today, Schuman is in Tuskegee listening to his boss lead a discussion of the study's progress over the past couple decades. There are questions to be answered among the doctors gathered, but of course the most important question is, should the study persist? All the test subjects are now either old or middle aged. Schuman hopes desperately that no one will demand the study end. Like his predecessors, he believes that they're still just too much to learn. Luckily, he's calling to greet. Schuman points out to the men gathered in the Tuskegee conference room that in fact, the age of the participants is a huge plus. Now the study can add a new focus in examining how changes in the body brought about aging differ from changes brought about by ongoing syphilis infection. Plus, Schuman's seen how much the test subjects like the doctors now. On the occasions when the doctors visit the patient's homes, they receive humble but heartfelt gifts, cookies, cornbread, whatever else the Negroes can make. They're not treated for syphilis, but they're treated for other things and grateful for the medical attention, as they should be. The PHS and Tuskegee Institute Schuman things are doing these many many favors. The men in the room today know the program as the Tuskegee study of untreated syphilis in the Negro male. The patients know it as the more innocuous Tuskegee Medical Research Study. And what's wrong with that? They're getting care their patients didn't receive that many of their neighbors couldn't even dream of. Schuman for his part declares that he'd like to see the study continue for another 20 years and beyond. It will end when the last subject dies and not one day before. That's just good science. In June of 1965, Dr. Erwin J. Schatz, 34 year old cardiologist at the Henry Ford Hospital in Detroit, sits down for a quiet evening. Sitting at home in his living room. The windows are open to let the cool air in and Schatz just wants to relax after a long day. He likes to stay focused on his profession even when he's away from the hospital, so for him, relaxing often means diving into the latest issue of a medical journal. He's especially interested in empathy and education in medicine. He picks up a recently published report and begins to read. His pulse quickens and his brow furrows. He can't believe what he's reading. Can't be real, can't it? Why is this being discussed so casually in the open? Is there something he's missing here? He read it again. Has someone gone mad? Black test subjects deceived, potentially life saving treatment withheld and has gone on for 30 years. He rushes to a study, sits down before his typewriter, tries to keep his rage in check. Days later, Dr. Anne Q. Yobbs at the Centers for Disease Control sorts through her mail. She opens a letter from Erwin J. Schatz and begins to read. She's astonished. It reads, I'm utterly astounded by the fact that physicians allow patients with a potentially fatal disease to remain untreated when effective therapy is available. If this is the case, then I suggest the United States Public Health Service and those physicians associated with it need to reevaluate their moral judgments in this regard. Yobbs wrinkled her forehead. She jots down a quick note and staples it to Schatz's letter. When she slips the letter in a file and buries the file deep in a basement cabinet, no one ever checks. Her note reads, this is the first letter of this type we have received. I do not plan to answer this letter. Next on American Scandal, the whistle is blown on the Tuskegee study. The fallout is severe and the fight for justice begins. I'm wondering, this is American Scandal. 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 executed produced by me Lindsey Graham for Airship. Sound designed by Derek Barrens. This episode is written by Hannibal Diaz, editing by Casey Meier. The producers are Stephanie Gens, Jenny Lauer Beckman, and her nonlopus for wandering.