Oslo study
Untreated syphilis study that informed the Tuskegee Syphilis Study.
The Oslo study (1891–1910) was an observational study of untreated syphilis conducted at Oslo University Hospital, Rikshospitalet in Oslo, Norway. Under Cæsar Boeck, treatment was withheld from approximately 2,000 patients. Its results later influenced the Tuskegee Syphilis Study (1932–1972).
Quick Facts
- Location
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Period
- 1891–1910
- Supervisor
- Cæsar Boeck
- Number of patients
- approximately 2,000
- Average hospital stay
- 3.6 months
- Follow-up study period
- 1925–1927
- Follow-up researcher
- Edvin Bruusgaard
Facts from the source article.
Background
In the 18th century, mercury, typically as mercuric chloride, was the standard treatment for syphilis, based on the belief that induced sweating and salivation purged harmful substances. As mercury poisoning became better documented in the 19th century, many physicians rejected it. Rapid urbanization and poverty increased syphilis cases in Norway during the 1870s and 1880s, and economic conditions also expanded prostitution. Prostitutes were arrested and publicly examined; those with symptoms were involuntarily hospitalized.
Study
Cæsar Boeck, head of the Department of Dermatology at Oslo University Hospital, considered mercury ineffective and believed it interfered with natural defenses. He prohibited mercury use and withheld all treatment from patients with primary and secondary syphilis. Between 1891 and 1910, about 2,000 patients were denied treatment. Boeck recorded detailed observations; patients were hospitalized until symptoms cleared, averaging 3.6 months (range 1–12 months). Boeck may have been influenced by his uncle Carl Wilhelm Boeck, who opposed mercury and used inoculation with infectious material from early-stage chancres, exposing 1,075 patients with negative health effects. Cæsar Boeck instead recommended rest and diet, and began administering Salvarsan in 1910 after its introduction. Between 1925 and 1927, Edvin Bruusgaard followed up 473 former patients, publishing in 1929 that 27.9% had been spontaneously cured and that 70% were not inconvenienced, though 30% experienced severe symptoms including cardiovascular disease and premature death.
Impact on the Tuskegee Syphilis Study
The Oslo study greatly influenced the Tuskegee Syphilis Study (1932–1972). Bruusgaard's 1929 paper was the only available study of untreated syphilis when the U.S. Public Health Service commissioned Taliaferro Clark's proposal in 1931. While Gjestland worked on his thesis, American researchers involved in Tuskegee showed interest: Joseph Earle Moore visited Oslo in 1947 to review Gjestland's data, and J.R. Heller of the Venereal Disease Division also expressed interest. Gjestland received funding from the U.S. Public Health Service and met with Tuskegee researchers at Columbia University; their research appeared in chapter 2 of his thesis. Based on the Oslo study, Tuskegee researchers determined syphilis was more dangerous and transmissible without treatment. Moore stated the Oslo study should never be repeated, yet justified the Tuskegee study by claiming African Americans were less intelligent and more promiscuous, and unlikely to seek treatment. Moore asserted that syphilis in African Americans was almost a different disease. The Oslo experiment likely influenced Hugh S. Cumming's hypothesis that the Tuskegee study might show treatment was unnecessary.
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