Summary

This document provides background on the educational and health and medical services programs of the Julius Rosenwald Fund (Fund) with a specific focus on the six U.S. Public Health Service (USPHS) syphilis incidence and treatment projects for African Americans in the South supported by the Fund between 1929–1931. These projects showed that the incidence of syphilis among African American communities varied based mainly upon socioeconomic differences and that state-of-the-art medications for syphilis at that time could be administered to rural underserved populations. In 1932, the Fund discontinued further research with the USPHS on the treatment of syphilis. In 1937, the Fund supported a recheck on the status of participants in the prior syphilis control demonstration project in Macon County, Alabama. The Fund did not contribute to the large-scale Tuskegee Syphilis Study, conducted between 1932 and 1972, which intentionally withheld treatment to the men participating in the study who had syphilis.

Introduction

In 1917, Julius Rosenwald, President of Sears, Roebuck & Company—and a noted philanthropist—created the Julius Rosenwald Fund “for the well-being of mankind.” The main thrust of the Fund prior to 1928 was the Rosenwald School Building Program. Between 1912 and 1932, first Julius Rosenwald individually and then the Fund partnered with nearly 5,000 African American communities in 15 southern states to help build schools that provided the education for their children that was either non-existent or greatly lacking. A total of 5,357 schools, teacher homes, and shop buildings were constructed. Nearly one-third of African American children in the Jim Crow South attended these schools and went on to lead the better lives that their parents so ardently desired for them. Many Rosenwald School alumni joined the Civil Rights Movement, most notably Congressman John Lewis and poet Maya Angelou.

In 1928, Julius Rosenwald hired Edwin Embree, a Vice President of the Rockefeller Foundation, to be the Fund’s President. With Rosenwald’s approval, Embree added fellowship and health and medical services programs to the existing education program in 1928. Under the fellowship program, which lasted from 1928 to 1948, nearly 900 highly talented people, most of whom were in the early stages of their careers, received awards; two-thirds were African Americans. Luminaries included Ralph Bunche, Dr. Charles Drew, Marian Anderson, W.E.B. DuBois, Langston Hughes, John Hope Franklin, Kenneth and Mamie Phipps Clark, James Baldwin, Zora Neale Hurston, and Ralph Ellison.

The Fund also supported early NAACP legal cases and contributed to a number of Historically Black Colleges and Universities, including Tuskegee, Fisk, Dillard and Howard Universities, and Morehouse College.

The health and medical services program focused on improving the health of African Americans through more accessible and better hospitals and clinics and better training for African American doctors, nurses, and midwives. The program also supported public health projects to demonstrate the feasibility of controlling the infectious diseases syphilis and tuberculosis and reducing the rates of maternal and infant mortality among African Americans. Total expenditures over the life of this program were $3.02 million—the equivalent of nearly $68.8 million in 2022.*

The Fund expended a total of $22.2 million from its inception in 1917 until its termination in 1948 in accordance with the dictates of Julius Rosenwald that the Fund terminate within 25 years of his death. About $19 million went to improve African American education and healthcare and to seek better race relations—the equivalent of about $433 million in 2022 dollars.

Fund Syphilis Incidence and Treatment Demonstration Projects

The syphilis demonstration program began in 1929 after Dr. Thomas Parran, then US Assistant Surgeon General, approached Dr. Michael Davis, general director of the Fund’s medical program. Dr Parran suggested that a joint project be undertaken by the USPHS and the Fund to demonstrate the possibility of mass control of syphilis among southern African Americans. The USPHS had just completed a survey of syphilis incidence in more than 2,000 African Americans employed by the Delta and Pine Land Company in Mississippi, in which nearly one-fourth of the employees had tested positive. The USPHS requested $10,000 from the Fund for a one-year demonstration project “to give adequate treatment for syphilis for this group.” The Fund agreed to the project, which commenced in late summer 1929.

The Fund also approved a new program in November 1929 for calendar year 1930 for “demonstrations of the control of venereal disease in the rural south, in cooperation with the PHS and with state and local authorities.” In addition to the study already underway in Mississippi, five further counties were selected for the demonstrations: Macon County, Alabama; Glynn County, Georgia; Pitt County, North Carolina; Tipton County, Tennessee; and Albemarle County, Virginia. These areas were chosen specifically to be dissimilar from one another, both geographically and economically, in order to develop data on the occurrence of syphilis under a variety of circumstances.

The six demonstration projects showed that the incidence of syphilis among African American communities varied based mainly upon socioeconomic differences. In Macon County, Alabama, where there was extreme poverty, high illiteracy, and a lack of medical and educational facilities, the rate was the highest—more than four times higher than in Albemarle County, Virginia, where the general economic status, schools, and medical care were significantly better.

The demonstration projects also showed that the state-of-the-art medications for syphilis of that time period could be administered to rural underserved populations. Those medications included bismuth and neoarsphenamine injections and mercury ointments administered on the skin. Long-term treatment was needed with those medications to effect cures, even though the treatments could produce serious toxic side effects.

Although penicillin was discovered in 1928, the pure compound was not isolated until 1940. Its effectiveness in treating syphilis was first shown on a small scale in 1943. Availability of penicillin for the widespread treatment and cure of syphilis and other bacterial infections did not occur until after World War II.

In their 1949 book, Investment in People: The Story of the Julius Rosenwald Fund, authors Edwin Embree and Julia Waxman stated with respect to the six demonstration projects, “While treatment had not been extensive enough to effect the cure of all patients, it had rendered most cases noninfectious and reduced suffering and disability.”

The Fund monitored the demonstration project in Macon County closely. H. L. Harris, Jr., an African American physician working for the Fund, made two site visits to Macon County during the course of the project. Following his second visit in the fall of 1930, he submitted a report questioning the feasibility of attempting to cure syphilis in the county until overall health and socioeconomic conditions were improved, noting that the community greatly needed a comprehensive health and social welfare program. He concluded that the syphilis demonstration project in Macon County had “accomplished all that can be hoped from it” and should not be extended.

Shortly thereafter, the Fund hired Dr. Charles S. Johnson, Chair of the Department of Social Science at Fisk University and later the University’s President, to perform a sociological study of 612 African American families from eight settlements in Macon County. A significant number of these families had participated in the 1930 syphilis control demonstration project. In his 1934 book on that study, Shadow of the Plantation, Johnson wrote that the Macon County demonstration project produced some social discoveries vital to health beyond the control of syphilis. These occurred because those undergoing treatment for syphilis were required to have preliminary general physical examinations that revealed the large incidence of other disabilities among the study participants. Dr. Johnson stated:

“Some 7,500 blood examinations and 3,200 urine analyses were made on those under treatment, and a total of 2,042 prescriptions dispensed during the first year. Apart from this, however, 3,500 typhoid inoculations were given, and 600 children immunized against diphtheria, and 200 vaccinated against smallpox. This altogether, with the Red Cross distribution of seeds for gardens and yeast to be used in combating pellagra, constituted one of the most intense concentrations upon a reconstructive health campaign of any rural section in the South.”

At its spring 1932 meeting, the trustees of the Fund voted to discontinue its support of projects with the USPHS on syphilis incidence and treatment. The dramatic decline in public revenue in the south due to the Great Depression precluded meaningful governmental and philanthropic participation in syphilis control studies. The Fund was also experiencing financial difficulties due to the stock market crash. And, the report from Dr. Harris, advising against an extension of the study in Macon County, Alabama, was available to them.

The Fund’s financial contribution to the six syphilis incidence and treatment demonstration projects was $72,900, equivalent to $1.73 million in 2022.

Tuskegee Syphilis Study

In the fall of 1932, a new large-scale syphilis research program, known as the Tuskegee Syphilis Study, was launched by the USPHS with participation by the Tuskegee Institute. The program lasted until 1972. The Fund did not contribute funds to the Tuskegee Syphilis Study, as its Trustees had voted to discontinue further syphilis control studies with the USPHS in the spring of 1932.

The infamous Tuskegee Syphilis Study followed a group of African American men with demonstrated, supposedly late-stage, non-contagious syphilis, who purportedly had not received prior treatment for the disease and who were not informed that they had the disease. They were not given treatment intentionally—even after penicillin was demonstrated to be curative for this stage of the disease by the mid 1950s. Instead, participants were subjected to ongoing medical observation, told that the aspirin, iron tonics, and vitamins given them were treatment, and that the diagnostic spinal taps were a “special treatment.” They were intentionally followed until their deaths. Funding from the Milbank Memorial Fund, a New York based public health foundation, made autopsies possible for about half the men by providing money for their burials. Only a few of the study’s participants had previously been part of the prior Fund demonstration project in Macon County because those men had received short-term treatments for syphilis.

Other Fund Syphilis Treatment Program

In 1937, the Fund renewed its support of syphilis research by conducting a recheck of participants in the original syphilis control demonstration project in Macon County, Alabama. The Fund sent African American physician Dr. William E. Perry of the Harvard School of Public Health to Macon County to oversee the recheck, which ultimately showed a reduction in the syphilis rate among participants. The USPHS purportedly took steps to help assure that none of the men being studied in the Tuskegee Syphilis Study were included in the 1937 Fund syphilis control program, although how or if the USPHS actually did it was disputed by some of the providers in this program.

The Fund also provided support to the John A. Andrew Memorial Hospital on the campus of the Tuskegee Institute for experiments on a county-wide basis in venereal disease control, the training of midwives, and the establishment of a nurses’ training course. The Fund’s contributions to the hospital totaled $64,500 (equivalent to $1.47 million in 2022).

Nationwide Syphilis Control Program

In the late 1930s, the US government launched a nationwide syphilis control program that included mass testing for the disease and nationwide mobile treatment clinics for both white Americans and African Americans. The techniques utilized in the six demonstration projects supported by the Fund contributed to the development and success of the national program, which ultimately helped contain the dreaded disease.

Input from Dr. James H. Jones and Dr. Susan M. Reverby

As part of its review of the six syphilis control demonstration projects, the Rosenwald Park Campaign interviewed Dr. James H. Jones, author of Bad Blood: the Tuskegee Syphilis Experiment, and Dr. Susan M. Reverby, author of Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. Both Dr. Jones and Dr. Reverby reviewed the draft version of this document and stated that the six USPHS demonstration projects supported by the Fund provided treatment to people diagnosed as having syphilis, and that the Fund did not support the Tuskegee Syphilis Study. Both scholars authorized the Campaign to use their names in this regard.

Conclusions

As part of its mission to improve the well-being of mankind and its commitment to significantly enhance the education and health of African Americans, the Julius Rosenwald Fund contributed to USPHS demonstration projects on the incidence and treatment of syphilis among African Americans in six counties of southern states between 1929–1931. One of these was Macon County, Alabama. These six studies showed that socioeconomic conditions contributed significantly to the incidence of syphilis within populations and that underserved rural populations could be treated on a repeated basis for syphilis. In the spring of 1932, the Fund trustees voted to discontinue its syphilis control program with the USPHS. In 1937, the Fund performed a recheck of participants in its prior syphilis control demonstration project in Macon County. The nationwide USPHS syphilis control program initiated in the late 1930s benefitted from the six Fund-supported syphilis incidence and treatment demonstration projects. The Fund did not contribute to the large-scale Tuskegee Syphilis Study, conducted between the fall of 1932 and 1972, which intentionally did not provide treatment to participating men with syphilis.

* In calculating the current value of the expenditures made by the Julius Rosenwald Fund for the various programs from the inception of the Fund in 1917 until its termination in 1948, it was assumed that all of the expenditures were made in 1933, the midpoint of the Fund’s existence. A multiplier from the Internet was then used to create the values as of 2022. This is not the most accurate way to derive these values, as all funding for the Rosenwald Schools Building Program was expended by the end of 1932. But it does provide a reasonable initial estimate of the magnitude of the individual programs and overall Fund expenditures.