ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
255 
256 
257 
258 
259 
260 
261 
262 
263 
264 
265 
Ibid; John Cutler to John L. Mahoney. (1946, November 30). Correspondence. PCSBI HSPI Archives, 
CTLR 0001192. 
John L. Mahoney to John Cutler. (1948, June 21). Correspondence. PCSBI HSPI Archives, CTLR 0001143; 
Lalcone, H.H., Harris, A., Olansky, S., Salvado, C., Cutler, J.C. (1953). A study of the Neurath 
Inhibition Phenomenon in the serodiagnosis of syphilis. American Journal of Syphilis, Gonorrhea, and 
Venereal Diseases 37(3): 264-272. Memorandum to Mr. Gustavo An[i]rada to Mr. C.H. Morrison re: 
Pay-Consultants; Doctors Funes and Salvado. (1950, April 5). Correspondence. PCSBI HSPI Archives, 
NPRC 0001964. 
Dr. Aragon was appointed director of the Orphanage in January 1946. Nuevo Director del Hospicio 
Nacional. (1946). Diario de Centro America, January 24. Dr. Aragon was the director at the Orphanage 
until 1951 when he was transferred. Homenaje al Doctor Aragon en sus bodas de oro profesionales. (1971). 
El Imparcial. December 4. 
Stout, G.W., Cutler, J.C., op cit., p. 237; see generally Aragon, H.A. (1948, October). Estudio de la sifilis y 
pruebas de la serologia en el Hospicio Nacional de Guatemala. Salubridady Asistencia, Levitan, S., et al. 
(1952, July). Clinical and serologic studies with reference to syphilis in Guatemala, Central America: I. 
Studies of comparative performance of the Kahn, Kolmer, Mazzini, and VDRL slide tests as carried out in 
the National Orphanage. American Journal of Syphilis, Gonorrhea, and Venereal Diseases 36:379. 
At the completion of the research Dr. Cutler concluded that the Kahn and Mazzini tests yielded yield high 
numbers of false positives whereas the Kolmer and VDRL slide tests had better specificity (accuracy). 
Funes, J.M., Cutler, J.C., Levitan, S., Portnoy, J., Funes, R. (1953). Estudios serologicos y clinicos con 
referenda a la sifilis in Guatemala, Centro America:II. Observaciones efectuadas en un grupo de ninos de 
escuela en el Puerto de San Jose. Boletln de la Oficina Sanitaria Panamericana 34(1):14-18. The first two 
methods using lipoidal antigens resulted in significant numbers of false positives because the antibodies 
reacting with the antigen are not specific to syphilis. In fact, these antibodies can be present in numerous 
other conditions, including malaria and leprosy. Kahn, R.L. (1972). Syphilis serology with lipoidal antigen: 
The meaning of positive reactions. Journal of the National Medical Association 64(2):117-121. While 
cardiolipin antigens are also non-specific for syphilis, Dr. Cutler’s Final Syphilis Report cites a lower level 
of false positives through empirical testing: “flocculation tests using crude lipoidal antigen [the Kahn and 
Mazzini tests]. . .give a much higher rate of serological positivity than complement fixation tests using 
crude lipoidal or cardiolipin-lecithin antigens [the Kolmer test], or flocculation tests using cardiolipin- 
lecithin antigens [the VDRL slide test].” John Cutler. Final Syphilis Report. (1955, February 24). PCSBI 
HSPI Archives, CTLRJ)000675. 
Dugdale, D.C. (2009, December 1). National Library of Medicine and National Institutes of Health. 
Medline Plus, Serology. Available at http://www.nlm.nih.gov/medlineplus/ency/article/003511.htm. 
Dugdale, D.C. (2009, December 1). National Library of Medicine and National Institutes of Health. 
Medline Plus, Cerebral spinal fluid (CSF) collection. Available at http://www.nlm.nih.gov/medlineplus/ 
ency/ article/003428.htm. (accessed September 8, 2011). Contemporaneous literature discusses the 
“fundamental importance” of spinal fluid examination in the detection of syphilis: “a guide to the effect of 
and need for treatment in both early and late neurosyphilis, the examination of the spinal fluid has become 
indispensable, and failure to insist on the test may rank as culpable negligence.” Stokes, J.H., Beerman, 
H., Ingraham, N.R. (1944). Modern Clinical Syphilology: Diagnosis, Treatment, Case Study. Philadelphia: 
W.B. Saunders Company, pp. 1094-1114. 
John Cutler to John F. Mahoney. (1946, November 12). Correspondence. PCSBI HSPI Archives, 
CTLR 0001196. 
Stout, G.W. (1962). Personnel Files, Nomination for Departmental Honor Award. PCSBI HSPI Archives, 
PCSBI HSPI Archives, NPRC_0002555. 
John Cutler to John F. Mahoney. (1946, November 12). Correspondence. PCSBI HSPI Archives, 
CTLR 0001196. 
John Cutler to John F. Mahoney. (1946, December 6). Correspondence. PCSBI HSPI Archives, 
CTLR 0001253. The VDSPH was a hospital primarily for commercial sex workers in Guatemala who 
were required by law to report to Prophylactic Dispensaries twice a week for physical exams. Reglamento 
de la Seccion de profilaxia y de enfermedades venereas: Leyes conexas con el mismo. (1938, June). 
PCSBI HSPI Archives, CTLR 0001692-1693. Dr. Funes “was responsible for medical supervision of 
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