The Story of CC18

Theodore Meadough, Department of Biology, Howard University ’17

Jermaine Ehizele Robertson, Department of English, University of California, Berkeley '17


Editor’s Note     

This series of biographical sketches were authored by the 2015 class of the Howard University branch of AAMC’s Summer Medical Dental Enrichment Program at the W. Montague Cobb Research Laboratory. The students were assigned a Cobb Collection Individual and conducted research about that individual. The papers were reviewed by The Backbone Editorial Team and the name of the CC individual was redacted.

CC 18  was born in South Carolina, approximately in the year of 1903. It can be speculated CC 18’s birthplace was Rock Hill, South Carolina as both his parents were born there. Although slavery was abolished in 1865, during this time African Americans were faced with many obstacles. Due to being born in the South, CC 18 was not only introduced to an atmosphere full of violence, but an environment that was segregated. Between the end of the nineteenth-century and early twentieth century African Americans had a difficult time establishing their presence in a predominantly White society. Blacks were terrorized for attempting to access the same resources to which Whites were privileged. Traumatizing events such as being spat on, raped, burned, and lynched were commonplace incidents that victimized Blacks in the South (Washington). Violence was not the only issue for African Americans living in the South; Jim Crow Laws, laws that were racially discriminant and disenfranchised African Americans, added more harsh treatment to their cruel circumstances. In a legal sense African Americans were “separate but equal,” however this was not their reality (Dred Scott). Opportunities and privileges were not the same for Blacks as for Whites. Jim Crow Laws embodied White privilege as they enforced racism through segregation of public schools, public transportation, and public places such as restrooms, restaurants, and drinking fountains (Sandoval- Strausz).Southern states were also struggling with issues such as The Great Migration and The Great Depression. The Great Migration was a time period where one and a half million African Americans relocated from the south into western and northern states in quest of equality, along with escaping unemployment and oppression (The Great Migration). Even though many families migrated in hopes of a decent living, the stock market crashed in October 1929 sparking The Great Depression (Romer). By this time CC 18 was about twenty-five years old and experiencing the economic pressures of banks closing down, cotton prices dropping, and a low number of job opportunities. Due to South Carolina’s economy being depressed prior to The Great Depression, the stock market crashing only worsened the socioeconomic conditions of the state (The New Deal). Despite the crash, Washington, DC suburbs continued to expand which may have been the reason CC 18 moved to the district in 1931 (B.3.3 Modern Period). Although it is feasible that CC 18 may have relocated in desire of a better lifestyle, he was soon faced with another impediment. Even with forward progression, African Americans did not benefit from the District of Columbia’s Federal expansion (B.3.3 Modern Period). It was difficult to make ends meet and even more so for Williams because he worked as a laborer. Having to work long hours, tirelessly for low pay could have been a daily source of stress worsening his already jeopardized health. CC 18 was suffering from syphilis presumably in its late stages since he would die a short time after moving to Washington, DC. Along with extensive hours, working conditions were severely hazardous for all blue-collar workers during the early 1900’s (Tomyn, Media). As a laborer, CC 18 was at risk of death every minute on the job. He was regularly exposed to toxic fumes and excessive heat while working in small spaces with improper ventilation. Working in these conditions did not aid in his overall health at all. CC 18 died at the young age of 28, February 18th, 1932 in Gallinger Municipal hospital due to his syphilis infection. 


    Syphilis is a highly contagious bacterial infection that is primarily spread by sexual contact. Syphilis may also be transmitted from mother to fetus during pregnancy, labor, or breastfeeding, resulting in congenital syphilis. Infants with congenital syphilis may have symptoms at birth, but it is not unusual for symptoms to develop later in life. Syphilis is caused by the spirochete bacterium Treponema pallidum. Even the very first sign of syphilis, designated to be a painless sore, can be easily confused for an ingrown hair, zipper cut, or any other seemingly innocuous bump. Syphilis infections in adults can be divided into different stages: primary, secondary, latent, and tertiary. The primary stage of syphilis is characterized by one or more painless ulcers, denoted as chancres, appearing at the site of infection.  Chancres contain millions of syphilis bacteria and are highly contagious. On average chancres will appear three weeks after initial contact with syphilis. The usual locations for chancres are around the anus, mouth, or genital area. If left untreated, the ulcers can take anywhere between two and six weeks to heal (Syphilis).


    If the infection has not been treated it will progress into the secondary stage, which will occur six weeks to six months after initial exposure to syphilis. The secondary stage is known to manifest in a variety of ways, symptoms most commonly involve the skin, mucous membranes, and lymph nodes. The most visible symptom is a non-itchy rash covering the whole body, particularly the extremities, including the palms and soles. Another perceptible symptom is white patches on tongue or roof of the mouth. These rashes are akin to chancre in that they carry millions of syphilis bacteria and are highly infectious. Other, less discernible symptoms include a flu-like illness, loss of appetite, swollen glands, patchy hair loss, and chronic headaches. The latent stage of syphilis is characterized by a regression of symptoms where the infection lies dormant without causing symptoms. If no treatment is received, syphilis can remain inactive in the body for years without any signs of infection. Tertiary syphilis is the most violent form of the infection. At this stage syphilis can affect the heart and possibly the nervous system. Symptoms resultant of these affects includes difficulty coordinating muscle movements, paralysis, blindness, numbness, and dementia. In the tertiary stage of syphilis the disease can damage internal organs, which may eventually lead to one’s death (Syphilis). 


    An outbreak of syphilis occurred around the turn of twentieth century in the United States that is speculated to have infected “ten to fifteen percent of the general population” (Jabbour). Since syphilis was primarily contracted through sexual relations the stigma surrounding the topic dissuaded people from revealing their possible infection. This stigma may have caused CC 18 to avoid medical care in order to avoid being permanently exiled by his community. CC 18 may also been under more pressure to avoid such a label in order to protect his job as a laborer. The regressive effects of syphilis probably encouraged CC 18 to go on without seeking medical care as well. Limited access to healthcare due to segregation in the 1900s was also a factor that could have deterred CC 18 from getting treatment. Segregation would have also restricted CC 18 from educational attainment, which in turn could have helped him be properly informed about the illness from which he was suffering. However, it’s also a possibility that he contracted congenital syphilis from his mother because he died of syphilis at 28 years old. Symptoms of congenital syphilis can be latent in an infant until adolescent years. For CC 18 to have died from syphilis it had to be in its late stages meaning it resided in his body for many years. At the beginning of the 1900s, the medical establishment was relatively new and at its early stages of development as an organized profession. State licensing and certification of physicians was only emerging and as such there were many frauds in the healthcare system during this time. Syphilitics often sought the consultation of frauds or “quack” doctors, who offered baths, rubs, and hot springs as therapies for pain in order to protect their confidentiality (Jabbour). The fragile state of the healthcare system made the outbreak of syphilis difficult to contain because syphilitics did not view the institution as reliable. For example, the Tuskegee Syphilis Experiment (an experiment performed between 1932 and 1972 on four hundred black men in the late stages of syphilis) heightened African Americans skepticism towards physicians during that time. The experiment was meant to compare how syphilis affected African Americans as opposed to whites. African Americans were already experiencing a lack of quality healthcare, to be told they were being treated for “bad blood” without any knowledge they had syphilis was completely unethical. The only data collected for the Tuskegee Experiment was from the autopsies of the men (Resnik). Events such as the Tuskegee Experiment lead Blacks to be highly skeptical of the healthcare they were likely to receive if they sought out medical attention.


    One of the major issues physicians faced was simply assessing if their patients had syphilis. Physicians were not sure how to communicate with their patients about such a sensitive topic without making their patients feel they were invading their privacy. The personal complications that the diagnosis of syphilis could potentially cause a patient were also a burden physicians had trouble handling. Despite efforts of legitimate physicians like Dr. Cobb to stress the importance of consulting professional care so a proper diagnosis could be made patients wanted to conceal their infection. In order to mitigate the fear of patients due to the stigma attached to syphilis, the American Medical Association adopted “Principles of Medical Ethics” in May 1903 to replace its “Code of Ethics” from 1847 (Jabbour). The new principles established explicit guidelines for patient confidentiality. 
Fritz Richard Schaudinn, a German zoologist, and Erich Hoffmann, a dermatologist discovered the syphilis causing bacteria, Treponema pallidum, in 1905. Subsequently after, in 1906 August Paul von Wassermann, a German bacteriologist, developed a complement fixation serum antibody test for syphilis known as the Wassermann reaction. In 1909, German scientist Paul Ehrlich discovered arsphenamine, which would be marketed as Salvarsan. Released in 1910, Salvarsan was the biggest advancement in managing the spread of syphilis until its cure was found in the year 1943 (John). 

   CC 18 was infected with syphilis during a time when a healthcare system was barely emerging in the United States. The relationship medical professions had with the state and public was at best tenuous because of the unsure role of physicians and the ignorance of the public. It is likely if CC 18 did not have access to Salvarsan because of his unequal access to proper healthcare due to segregation. Cost may have also been a factor that discouraged CC 18 because of his low pay as a laborer and “many hospitals did not have provisions for the treatment of syphilis” (Jabbour). Even if CC 18 had the opportunity to receive any medical care it is very probable he refused because of the social stigma that coupled with syphilis. It is also likely that any hospital that admitted him did not have the provisions for the treatment of syphilis. A large part of the reason the syphilis outbreak was a significant challenge for medical practices was the stigma surrounding the disease due to the fact it was primarily transmitted through sexual contact. Syphilis was a disease that no one wanted to be unfortunate enough to be infected with and have to discuss with another. 


    Syphilis is now diagnosed by a blood test that is sometimes combined with an examination of lesions on the body. The human body’s immune system usually responds to syphilis by releasing antibodies that can be detected with a relatively inexpensive blood test. The antibodies produced by the body can stay in the blood for years after infection. The only limitation of a blood test is it cannot measure how long a patient has been infected with syphilis. It is highly encouraged that women receive a blood test nowadays given the risk of congenital syphilis (Syphilis). Discovered in 1928, and used as a cure for syphilis in 1943, penicillin is now widely used to treat the infection (John). A single dose of penicillin is most effective in treating early stages of syphilis, but it is still fairly effective in treating later stages of the disease. However, if the disease has progressed to the third stage when it can cause damage to the nervous system or internal organs then the effects will be incurable. As a substitute to penicillin for those who might be allergic for allergy purposes, azithromycin or doxycycline can be administered as well (Syphilis). After receiving medication routine check ups are advisable to ensure that the bacterial infection is completely eradicated. 


    Today, if CC 18 had contracted syphilis, he would have found that seeking treatment is relatively simple. CC 18 would only need to search for the nearest clinic or health center that administers blood test and treatment for sexually transmitted diseases. CC 18 also would not have had to deal with the pressure of being labeled an exile because much of the social stigma surrounding sexually transmitted infections has dissipated over the decades. CC 18 could find solace in knowing that patient confidentiality is a much more strict policy today than it was at the beginning of the twentieth century. Many of the socioeconomic barriers impeding CC 18 from seeking treatment such as his wages as a laborer or segregation are not an issue in modern day times. Treatment for sexually transmitted diseases is widely available to all from many sources for low cost. It is worth noting that there are still many disparities throughout the healthcare system in the United States today. For instance, minorities continue to be underrepresented within the medical workforce, despite the country becoming more diversified. Minorities are also less likely to have access to medical institutions for an abundance of reasons. Through research projects similar to those conducted at the Cobb Research Lab it is possible to eliminate these disparities by bringing attention to them.  Despite the health disparities that exist within the United States, it is likely that if CC 18 contracted syphilis today he would have lived a much longer life instead of dying tragically at the young age of 28, due to improper health care.***


References

“DRED SCOTT v. SANDFORD.” Dred Scott v. Sandford. Web. 08 July 2015. <http://www.oyez.org/cases/1851-1900/1856/1856_0/>.
Frith, John. “Syphilis – Its Early History and Treatment until Penicillin and the Debate on Its Origins.
”JMVH. Web. 08 July 2015. <http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/>.
“The Great Depression and the New Deal.” Choice Reviews Online 39.01 (2001). Web. 8 July 2015.
Jabbour, Nicholas. “Syphilis from 1880 to 1920: A Public Health Nightmare and the First Challenge to Medical Ethics.” Syphilis from 1880 to 1920: A Public Health Nightmare and the First Challenge to Medical Ethics. Corcoran Department of History. Web. 08 July 2015. <http://www.uri.edu/artsci/com/swift/HPR319UDD/Syphilis.html#n50>.
“The Modern Period ( 1789-1999).” 1999 (2002). Web. 8 July 2015.
“National Institute of Environmental Health Sciences.” Research Ethics Timeline (1932-Present). Web. 08 July 2015. <http://www.niehs.nih.gov/research/resources/bioethics/timeline/>.
Romer, Christina D. “The Great Crash and the Onset of the Great Depression.” Oxford University Press. Web. 8 July 2015. <http%3A%2F%2Fwww.jstor.org%2Fstable%2F2937892%3Fseq%3D1%23page_scan_tab_contents>.
Sandoval- Strauz, A. K. “Travelers, Strangers, and Jim Crow: Law, Public Accommodations, and Civil Rights in America.” American Society for Legal History, 2005. Web. 8 July 2015. <http%3A%2F%2Fwww.jstor.org%2Fstable%2F30042844%3Fseq%3D1%23page_scan_tab_contents>.
“Syphilis Symptoms, Causes, and Diagnosis.” WebMD. WebMD. Web. 08 July 2015. <http://www.webmd.com/sexual-conditions/guide/syphilis>.
“Syphilis.” Syphilis. Web. 08 July 2015. <http://www.niaid.nih.gov/topics/syphilis/pages/default.aspx>.
Tolnay, Stewart E., and E. M. Beck. “Racial Violence and Black Migration in the American South, 1910 to 1930.” American Sociological Association. Web. 8 July 2015. <http%3A%2F%2Fwww.jstor.org%2Fstable%2F2096147%3Fseq%3D1%23page_scan_tab_contents>.
Tomyn, Rosanne, and Demand Media. “What Were the Work Conditions in American Factories in 1900? | The Classroom | Synonym.” The Classroom. Web. 08 July 2015. <http://classroom.synonym.com/were-work-conditions-american-factories-1900-23383.html>.
Washington, Margaret. “Obstacles Faced by African Americans.” PBS. PBS. Web. 08 July 2015. <http://www.pbs.org/wgbh/amex/1900/filmmore/reference/interview/washing_obstaclesfaced.html>.
Wormser, Richard. “The Great Migration.” PBS. PBS. Web. 08 July 2015. <http://www.pbs.org/wnet/jimcrow/stories_events_migration.html>.

Theodore Meadough is a Junior, Biology major at Howard University from Spring, Texas. Theodore is a member of the Howard University Black Literature & Hip Hop Workshop, the Health Professions Society, and is a member of the Beta Kappa Chi National Scientific Honor Society. As a devoted community leader, Theodore serves as a member of AmeriCorps volunteering with the Jumpstart program working with preschoolers in low-income neighborhoods. He aspires to pursue a profession in medicine in hopes of one day providing free services to health care in communities where people lack access to quality medical attention.

 

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Mr. Jermaine Ehizele Robertson (ehizelejones95@berkeley.edu) currently attends the University of California, Berkeley in pursuit of a bachelor’s degree in English with an emphasis on pre-medical studies and minor in African American Studies. Mr. Robertson received his high school Diploma from A.B. Miller High School in Fontana, California. Mr. Robertson graduated as the Valedictorian of his class and earned the honor of being distinguished as Student of the Year as well. Although Mr. Robertson ultimately aspires to be an orthopedic surgeon with his own private practices, his interest in English pertains to his desire to teach English abroad following his undergraduate career. Mr. Robertson is interested primarily in health-related apprenticeships and research opportunities in order to fortify his medical school candidacy. Mr. Robertson is particularly interested in activities that give him the opportunity to stimulate scientific rigor, become more culturally aware, better understand human behavior, and appreciate societal structure and function in respect to medicine. Mr. Robertson’s life passion is to become a modern day renaissance man and he chooses to pursue this passion by placing himself in a multitude of varying experiences. Mr. Robertson strongly believes that one’s life value can only be measured by the amount of lives one touches.


Cobb Lab