Pathology Spotlight: Advanced neurological syphilis and the Tuskegee study

In July’s Pathology Spotlight, Ken Donaldson, Senior Museum Research Fellow, takes a look at a specimen showing neurological syphilis. He also discusses the highly unethical Tuskegee Study.



This specimen is of the dura mater, the outside covering of the brain. Normally this is a thin membrane as visible at the top and bottom of the specimen. This specimen, however, features a large soft swelling called a gumma (G) that is seen in advanced syphilitic infection.

Syphilis is caused by a bacterium called a spirochaete, that is caught through sexual contact. Untreated syphilis affects many parts of the human body, although not all people are affected severely and some individuals show little progression or ill effects of the infection. In some people however, syphilis has a complex course including a primary stage featuring a painless sore on the genitals then, a few weeks later, a secondary stage comprising a rash, hair loss and small growths on the genitals. If the third stage is reached (tertiary syphilis), which may be years after the primary stage, the infection has become more severe and widespread, causing serious damage to the heart, brain and bones with a risk of stroke, blindness, heart problems and dementia.

In the early part of the 20th century the course of syphilis was not well understood and this occasioned a famous example of a highly unethical medical study in the Southern US state of Alabama, in the town of Tuskegee. The local branch of the government’s Public Health Service initiated a study in which 400 men with the infection were enrolled to determine the course of syphilis that was untreated. Importantly all of the subjects were impoverished black Americans with little education- there were no white Americans enrolled in the study. The aim was to deny treatment to the 400 syphilitic men by not disclosing to them that they had syphilis; instead they were told they had ‘bad blood’. The doctors then monitored the men to see how the disease progressed. Denial of treatment at the start of the study was ethically wrong of course, but treatment in the 1930s was often ineffective and used drugs like mercury and arsenic that were in themselves quite harmful. However, 15 years or so into the study, in the forties, penicillin became available, which was an effective and complete cure for syphilis; notwithstanding this the doctors running the study withheld penicillin treatment from the 400 men in order that the study should proceed to its conclusion. Many of these men developed the serious complications mentioned above, suffered and died as a result of not being treated with the penicillin that would have cured them. Additionally, as they remained infectious, some of their wives and children also contracted the disease. It was not until 1972, 40 years into the study, that its racist and unethical nature was made public by a ‘whistleblower’ and the study was terminated. The surviving men eventually received some compensation and in 1997, also received a full apology from US President Bill Clinton who said “What the government did was shameful, and I am sorry.”

The Tuskegee scandal hits the New York Times in July 1972. 


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