The tragedy of syphilis patients, the apology of the US president, and the extremely immoral Tuskegee experiment

Author: Digoxin

On the afternoon of May 16, 1997, a solemn and dignified apology ceremony was held in the East Room of the White House. The guests were dressed in formal attire and sat quietly in their chairs, and the reporters had their cameras ready to shoot at any time. As solemn music sounded, the eight most important guests entered the venue. These guests were very old, and most of them entered in wheelchairs. After these important guests sat down in the front row, everyone stood up and applauded. US President Bill Clinton walked into the venue in a black suit, and the ceremony officially began. Clinton's speech was the last part of the ceremony. After he came on stage, he shook hands and hugged Herman Shaw, a 95-year-old black man.

At 2:26 p.m., Clinton began his speech. As the speech progressed, Clinton's expression became more and more serious and solemn. He spoke every word slowly and clearly in a heavy voice: "The mistakes we have made cannot be corrected, but we must break the silence and we will no longer turn a blind eye to it. We look you in the eye and say on behalf of the American people that the U.S. government is shameful in this matter, and I apologize..."

Clinton's every word struck the hearts of the guests. Many people's thoughts drifted back to the evil experiment forty years ago, and the old man was the survivor of that evil experiment. This experiment was related to a terrible infectious disease, which, to some extent, rewrote the course of human history. It was syphilis. To fully understand what kind of shameful thing the US government did, we must know something about the history of syphilis.

Where do demons come from?

Everyone must be familiar with syphilis, but the origin of syphilis has always been controversial. Some people think it comes from America; some people think syphilis originally existed in Europe; some people think it originated in Africa; and some people even think it originated in ancient Guangzhou. However, the most mainstream view is that syphilis was brought to Europe from America by Columbus and his crew.

In March 1493, Columbus led his crew back to Palos Port, Spain from America. After more than half a year of voyage and exploration, the crew could not wait to have fun everywhere after returning home. A disease that people had never seen before spread in Spain. These patients suffered from skin ulcers, edema of limbs, rashes all over the body, and even mental disorders. Even Columbus himself had similar symptoms in several subsequent voyages and eventually died. In this way, syphilis appeared in human historical records for the first time.

In 1495, France invaded the Kingdom of Naples. At that time, there were many Spanish mercenaries in the French army. Facing the powerful enemy, the Italians surrendered decisively, and King Charles VIII of France entered Naples in style. The Italians were very "hospitable" and indulged in sensual pleasures with the French and Spanish. It was not until a year later that the Italians felt that the French had gone too far and drove the French out of Italy. In this way, syphilis was brought to Italy, and then from Italy to France. Because the French first saw syphilis and only knew that it was brought back from Naples by the expeditioners, they called it the Neapolitan disease.

In about 10 years, syphilis spread almost all over Europe, but it was no longer clear where the source of the disease was, but everyone knew that it was related to sexual relations between men and women. No matter what they did, they still had to save face, so countries were unwilling to claim the disease and began to blame each other: the French called it the Naples disease, the Italians called it the French disease, the British called it the Bordeaux disease or the Spanish disease, the Russians called it the Polish disease, the Poles called it the Germanic disease, and the Arabs called it the Christian disease. It was not until the 16th century that a Frenchman named Fracastro wrote a long poem about syphilis. In this poem, he used the word syphilis, which was the first time the word syphilis was proposed in English, and then the word gradually spread. Since the 18th century, people have widely used the word syphilis to refer to this disease.
The reluctance of all countries to acknowledge syphilis has a lot to do with the bad reputation of syphilis. Syphilis is a type of sexually transmitted disease, and there are three main ways of transmission. The first is sexual transmission; the second is blood transmission. For example, if a needle has just drawn blood from a syphilis patient and then draws blood from me, I may be infected with syphilis; the third is vertical transmission, that is, if a pregnant mother has syphilis, she may pass it on to her baby. This is very similar to the way AIDS is transmitted. After being infected with syphilis, an ulcer about the size of a dime usually appears on the skin, which is generally painless. If you leave it alone, it will heal on its own in 3-6 weeks. This is primary syphilis; it will develop into secondary syphilis, with macules and pustules on the skin, and hair loss.

If it continues to develop, it will become tertiary syphilis, which will cause damage to the skin, mucous membranes, and internal organs. Some patients with syphilis will have abscesses all over their bodies, sometimes even rotten to the point of exposing the bones; some will have heart disease; if the nervous system is affected, there will be hemiplegia, hearing loss, mental abnormalities, etc., and the symptoms are varied. When syphilis first broke out, it was very lethal, and the number of Europeans who died from syphilis at that time may have reached 10 million. In Europe in the 18th and 19th centuries, syphilis was very widespread. Many celebrities were suspected of having syphilis, such as Schumann, Van Gogh, Nietzsche, Mozart, etc. If not treated, the mortality rate of syphilis can reach 58% at its highest and 8% at its lowest. However, the incubation period of syphilis is sometimes very long, and it can exist in the body of the infected person for many years without any symptoms.

Conquering the Great Imitator

Syphilis was not only prevalent in Europe, but was soon spread to India by the British, and then to the Lingnan region of my country, and then to the north of my country and Japan. Indians called it Portuguese disease, and Japanese called it Tang sore. In my country, the most common name is "Yangmei sore", which shows that we were very kind at that time and did not blame other countries. The exact record of Yangmei sore in my country was in the 16th century. The most famous one is probably Li Shizhen's record in "Compendium of Materia Medica": "Yangmei sore is not recorded in ancient prescriptions, and there is no disease. Recently, it started in Lingbiao and spread to all directions. The climate and soil in Lingbiao are low and hot, and the wind and miasma are fumigated. The food is spicy and hot. Men and women are obscene. The damp heat evil accumulates deeply, and it develops into poisonous sores, which lead to mutual infection from south to north and all over the world." It can be seen that in Li Shizhen's time, people already knew the basic transmission method of this disease.

At 6 pm on January 12, 1875, that is, the 13th year of the Tongzhi reign of the Qing Dynasty, the tenth emperor Tongzhi died in the East Warm Pavilion of the Forbidden City. The royal family announced that Tongzhi died of smallpox, but the eunuchs and palace maids whispered behind his back: "I heard that the late emperor did not have smallpox at all, but syphilis..." At the same time, the rumor that Tongzhi died of syphilis became more and more popular among the people, and it was almost known to every household, and the degree of suspense was no less than the four major mysteries in the Qing Palace.
Did Emperor Tongzhi die of syphilis? There has always been controversy over this. Although the Qing government officially announced that Emperor Tongzhi died of smallpox, it is also true that Tongzhi often went to the Eight Great Hutongs to seek pleasure. People suspected that Cixi tried every means to conceal the fact that Tongzhi had syphilis in order to maintain the dignity of the royal family. This is not unreasonable, and the symptoms before Tongzhi's death were indeed very similar to syphilis. Later, Chinese historians and Chinese medicine experts conducted joint research and believed that Emperor Tongzhi died of smallpox, but they could not rule out the possibility that Emperor Tongzhi also had syphilis, but syphilis was not the cause of his death.

Why is the rumor that Emperor Tongzhi died of syphilis so widely circulated? In addition to Tongzhi's work style, an important reason is that, judging from the symptoms alone, syphilis is very similar to many other diseases, so syphilis has a nickname in Europe - the great imitator, it is too easy to be confused with other diseases. Before laboratory diagnosis and imaging diagnosis entered the clinic, diagnosis mainly relied on the four diagnostic techniques of "seeing, touching, percussion, and listening". "Seeing" refers to looking at the patient's condition; touching means touching; percussion means using a special technique to tap certain parts of the body and listen to the sound of percussion; listening means using a stethoscope to auscultate. At that time, diagnosing syphilis was really a challenge to the doctor's diagnostic ability. This difficulty in diagnosing syphilis did not change until the early 20th century.

In 1905, German microbiologists Schauding and Hoffmann discovered the Treponema pallidum, a twisted bacterium that looks like a small spring that causes syphilis.

The syphilis spirochete is very fragile. It can be said that it is afraid of dryness, heat, and oxygen. After leaving the human body, it will die after drying for 1-2 hours. Even hot soapy water can quickly kill the bacteria, so syphilis is generally not transmitted through toilet seats and bathtubs. In other words, if only in vitro experiments are done, Lianhua Qingwen Capsules will definitely kill syphilis. In 1907, German bacteriologist Wassermann improved the blood test method for syphilis, so that this serological diagnosis method that could only be used in the laboratory could also be used clinically. From then on, clinicians had bacterial and serological diagnostic methods, and they would no longer have a headache because of the diagnosis of syphilis. In 1909, Ehrlich invented the drug 606 for the treatment of syphilis, and syphilis finally received a truly effective treatment.

But medical scientists at the time were still troubled by a very critical problem.

The question about pure culture of Treponema pallidum in vitro is, is Treponema pallidum the direct cause of syphilis? According to Koch's postulates, to finally identify it as the pathogen of syphilis, the cultured single bacterium must be inoculated into healthy animals to infect the inoculated animals with syphilis. But this step has never been successful because it is difficult to culture Treponema pallidum in pure culture in vitro. If it is impossible to culture pure strains, it is impossible to implement the key step of Koch's postulates. This problem has been plaguing the medical community until a Japanese appeared.

In 1910, Hideyo Noguchi was doing pure culture of Treponema pallidum at the famous Rockefeller Institute for Medical Research. How to make culture medium is a very important step. Culture medium is like farmland. Only when the conditions of farmland are suitable can bacteria, the crop, grow. Noguchi tried rabbit plasma, horse plasma, and human serum, but none of them worked. The Treponema pallidum either died or grew a large number of other bacteria. Noguchi consulted a doctor at the institute, who suggested: "Try adding some fresh animal tissue to the serum."

Noguchi immediately adopted this suggestion. He understood that the reason for the mass death of syphilis spirochetes was probably that air was mixed into the test tubes used for culture, and the oxygen in the air caused the spirochetes to die quickly. Fresh tissues just peeled off from animals can still survive for a period of time and have very weak breathing. It is this weak breathing that can consume the annoying oxygen in the test tube. Although a good idea was thought of, there were still many difficulties in operation. At the beginning, Noguchi used animal muscles and livers, but they were too easily contaminated by bacteria, and the test tubes were always full of other bacteria. After many failures, Noguchi finally found that the kidneys or testicles of animals were more ideal. Therefore, the animal tissues added to the culture medium were determined.
However, the test of patience has just begun. Noguchi inoculated hundreds of test tubes at the beginning, but he had to continue to inoculate new ones every day, because each time a new inoculation was made, there were slight changes in the method of cutting animal tissue, the ratio of serum and water in the test tube, and even the degree of sealing of the test tube. It is very likely that it is this slight change that determines whether the syphilis spirochetes grow. So there were more and more test tubes, and later there were thousands of them. Noguchi had to check each one carefully. In order not to miss the growth of syphilis spirochetes and observe them at any time, Noguchi simply lived in the laboratory. In this way, until August 1911, Noguchi finally saw the reproduction of syphilis spirochetes. He was so excited that he danced in the studio in front of his colleagues.
After successfully cultivating the syphilis spirochete, Noguchi found the syphilis spirochete in the brains of patients with paralytic dementia. These two discoveries made Noguchi famous. In Japan, he is a household name, his portrait is used on the 1,000 yen banknote, and there are plots about him in "Doraemon" and "Chibi Maruko-chan".

He was nominated for the Nobel Prize many times in his life, but never won it. He is also a controversial figure. On the one hand, the quality of his papers was mixed and controversial; another reason was related to ethics: after successfully cultivating the syphilis spirochete, Noguchi wanted to further produce a syphilis vaccine, but he actually conducted experiments on 236 people without the knowledge of the parties involved. Later, he was sued for this incident. However, compared with the Tuskegee experiment in the United States, this incident is nothing.
The evil Tuskegee experiment
1932 was a special year for Eunice Rivers, a nurse from Macon County, Alabama, USA. She was assigned by the Tuskegee Institute to participate in a syphilis study. When the institute encouraged Rivers to participate in the study, they praised the study to the skies, saying: "This is a great study that is rooted in the black community and benefits mankind. The institute has developed a detailed plan to study syphilis, and the director also strongly recommends you to participate. The subjects we want to recruit are all African American men. You are also African American and have been involved in community work. Black people are more likely to trust you, and you can carry out the research more smoothly."
At that time, racism was rampant in the United States, and the blame for the spread of syphilis was also put on black people. Rivers was excited after hearing this, but she still had concerns and said, "But I don't know anything about syphilis!" The hospital staff said, "It doesn't matter, you just need to record it. If those people ask what disease you have, just answer 'bad blood'." Rivers said puzzledly, "Bad blood is just a local dialect, not a formal name, and it may include syphilis, anemia, fatigue and many other conditions." The hospital staff replied, "Just say bad blood, don't worry about anything else."

So, Rivers told the recruited subjects over and over again: "You have bad blood, you can get free examination and treatment, free food, free funeral, which is good for you." For those poor black people, free food is still very tempting, so they joined the experiment one after another. In this way, at the beginning of the experiment, Tuskegee Institute recruited 399 syphilis patients and 201 healthy people, all of whom were black. But they later learned that the examination was not a simple blood draw, but also included lumbar puncture and extraction of cerebrospinal fluid. The free food was a lunch on the day of the examination, and the free funeral cost was an autopsy.

If it were just this, the Tuskegee Study would not be so notorious. In fact, it was just a research project to observe how syphilis patients naturally evolve. The study was originally planned to take 6 months, but it lasted for 40 years. During these 40 years, the doctors did nothing to them except observe and record the physical changes of the patients. Those recruited syphilis patients not only did not receive basic treatment, but their conditions were even deliberately concealed by the doctors. The doctors who were supposed to cure diseases and save lives allowed syphilis to wreak havoc on these black people, and watched indifferently as the patients' conditions worsened day by day. The ulcers and abscesses caused by syphilis grew on the patients day by day, and the damage to their internal organs became more serious day by day. The doctors just filled in the experimental data like watching mice in a cage. What they had to do was just to study how syphilis would develop without any intervention. Because the patients did not know that they had syphilis, they actually became uncontrolled sources of infection, and the doctors watched these syphilis patients spread the disease to their wives and children without any intervention.

What is even more shocking is that these black people were repeatedly deprived of the opportunity to be cured. During World War II, 250 experimental subjects were drafted into the army. They were diagnosed with syphilis by the military, so the military asked them to be treated before joining the army, but even so, these experimental subjects still did not receive treatment. By 1947, penicillin became the standard drug for syphilis. In order to cure syphilis, the US government specially sponsored several public health projects. However, when the project team came to Macon County, the Tuskegee researchers still tried every means to obstruct and prevent these patients from participating in treatment. When the Tuskegee experiment ended, only 74 subjects were still alive. Among the initial 399 syphilis infected people, 29 died directly from syphilis, 100 died from complications of syphilis, 40 subjects' wives were infected with syphilis, and 19 subjects' children were born with syphilis. The Tuskegee experiment was a human experiment conducted by deception and concealment, and the subjects were African-Americans who suffered from racial discrimination. In my mind, the only thing that can be compared to this is the inhumane experiments conducted by the Japanese Unit 731. Nurse Rivers participated in the research for 40 years. Later, she said in an interview: "What you do in the dark will one day be exposed to the sun..."

In 1972, due to insider revelations, The Washington Star and The New York Times revealed the inside story of the Tuskegee Experiment, which attracted the attention of the entire United States. This longest medical experiment in history that did not treat humans was terminated. This experiment had seriously violated the spirit of the Nuremberg Code and the Helsinki Declaration. Later, the victims collectively sued the US government, and in 1974, they received a total of $10 million in compensation from an out-of-court settlement.
In 1997, the victims of Tuskegee finally received an apology from the US government. On May 16, then-US President Bill Clinton, on behalf of the US government, solemnly apologized in person to the eight surviving participants of the Tuskegee experiment or their families in the East Room of the White House. Herman Shaw, who shook hands and hugged Clinton before he took the stage, was the subject of the control group, numbered 478.

Figure: List of Tuskegee subjects (partial) No. 478 is Herman Shaw. The situation remains severe. The syphilis epidemic in our country was once very serious. At the beginning of liberation, 5% of people in cities in some areas suffered from syphilis. Since the founding of New China, great achievements have been made in syphilis control, and syphilis is managed as a Class B infectious disease. In 1964, my country became the first country in the world to basically eliminate syphilis at the national level. However, since the 1980s, syphilis has revived. In the past 20 years, the incidence of syphilis has been ranked among the top three infectious diseases, and the epidemic situation is very severe. In 2019 alone, there were 30,708 cases of syphilis reported in Zhejiang Province. It is preliminarily estimated that there are about 3 million people infected with syphilis nationwide, which is equivalent to the population of Mongolia.

From a global perspective, the prevalence of syphilis is still worthy of vigilance. According to the 2013 World Health Report of WHO, 2 million pregnant women are infected with syphilis every year, and more than half of them will transmit syphilis to their newborns, causing premature births, stillbirths, and low-birth weight babies. By 2016, the situation was still very serious. The WHO estimated that 6.3 million people were newly infected with syphilis that year, in other words, more than 17,000 people were newly infected with syphilis every day. In 2016, about 1 million pregnant women had active syphilis, resulting in more than 350,000 adverse births, including 200,000 stillbirths or neonatal deaths. However, the vaccine for syphilis has not yet been successfully developed.
Therefore, the demon of syphilis has never gone away. Don't think that it is an infectious disease that has nothing to do with us like smallpox. It is very necessary to keep oneself clean and learn to protect oneself. It is also very necessary to participate in premarital examinations and prenatal examinations. If pregnant women with syphilis can be discovered as early as possible, there is a chance to prevent the occurrence of congenital syphilis in the fetus. Today, the diagnosis of syphilis is very convenient and accurate. The syphilis screening RPR test can be obtained immediately. The penicillin used to treat syphilis today is much better than the 606 of the year in terms of efficacy and side effects.
Looking back at the history of human struggle against syphilis, what impressed me most was the Tuskegee experiment. If we do not keep medical ethics in mind at all times, medicine, which is supposed to cure diseases and save lives, is likely to become a more cruel tool of oppression by one group of people against another. Among all scientific research fields, medicine is a field that particularly needs to maintain the bottom line of scientific ethics. The news that He Jiankui violated medical ethics and conducted human gene editing experiments without authorization is still in front of us. On the issue of new drug approval and listing, we must also have the bottom line thinking of medical ethics, and we must not break it easily. At the beginning of 2020, the whole nation was hotly discussing whether Li Yuehua should be arrested. In fact, if we use medical ethics to consider this issue, the answer is obvious. With the development of human medicine to this day, it is a violation of medical ethics to test various new therapies on patients without ethical review. As the times advance, the bottom line of human medical ethics will become higher and higher, which is a manifestation of the progress of civilization.