“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
In order to enable calculation of the number of subjects exposed to syphilis, 
gonorrhea, and chancroid, an additional column was added to the database: 
“STD Exposure.” Based on data available about each unique individual, the 
STD Exposure column was populated with the disease used in exposure, for 
those individuals who were exposed. Frequently the disease involved in the 
exposure was explicit, but in instances where it was not, the disease was deter- 
mined based on knowledge about the exposure methods used for each disease 
and the populations in which various experiments were conducted, based on 
the retrospective reports that Dr. Cutler authored on the experiments. 
In a second round of data review, an attempt was made to fill in missing 
but known data (e.g., if there are 12 lines about A. Gomez — per the Full 
Name Clean column — and one of them lists age, age was filled in for all 
corresponding lines about him). In cases where an individual’s population 
(Commercial Sex Worker, Prisoner, Psychiatric Patient, Soldier) was missing, 
an effort was made to determine the population by comparing the date and 
nature of the experiment in which the individual was involved with the time- 
line of all of the experiments (assembled from Dr. Cutler’s final reports.) 
In cases where there was an obvious conflict between the database and Dr. 
Cutler’s reports (e.g., chancroid inoculation in a population not reported 
by Dr. Cutler to have been involved in chancroid experiments), the original 
archive documents were checked and the data verified or corrected. There were 
a number of commercial sex workers who were mentioned in the documents 
and were referred to Dr. Cutler for potential involvement in the inoculation 
studies, but who never participated. These individuals were identified as a 
discrete population (“Referred by VDSPH”) and included in the database, 
but in all cases, the only data available for these individuals were gonorrhea 
test results. The database was also double checked for individuals who have 
the exact same name in the Full Name Clean column, but were clearly not the 
same person (e.g., A. Gomez who was in the prison and A. Gomez who was 
in the mental health hospital), to ensure that both individuals were counted. 
Challenges in distinguishing between penicillin used as a prophylaxis for 
syphilis following exposure and penicillin used as a treatment for diagnosed 
syphilis infection arose. After consulting with Dr. Zenilman, the following 
standard was applied: as the incubation period of syphilis for lesion devel- 
opment is mean 21 days, all dosages of penicillin before 21 days were 
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