ENDNOTES 
X 
for approval. R.C. Arnold to John Cutler. (1947, December 30). Correspondence. PCSBI HSPI Archives, 
CTLR 0001108. The topics of the congress included: “a) Valuation of penicillin in the treatment of 
syphilis; b) Evaluation of semi-intensive 20-day arsenotherapy; c) Study of the action of sodium, salicylate 
in the treatment of venereal lymphogranuloma and appreciation of other methods of treatment; d) Results 
obtained on the repressive system of prostitution in general and related studies on its economic aspect; e) 
Evaluation of the probability of marriage among syphilitics treated with intensive systems; f) Venereal 
disease in infancy; g) Open topics always related to the general topics” [Translation]. Other topics to be 
addressed by sub-committees included: “a) Social and legislative problems; b) Gonorrhea; c) Psychiatry of 
prostitution; d) Neurosyphilis; e) Serology; f) Intensive treatment; g) Other venereal diseases; h) Venereal 
diseases and infancy; i) Penicillin therapy” [Translation]. (1948). Segundo Congreso de Venereologia 
el 25: Asistiran Observados de los Estados Unidos, Mexico y Cuba y Paises Centroamericanos. El 
Impartial. April 5, 1948. Attendants included Drs. Arnold and Spoto as well as “[f]our American doctors 
representing the army, navy, military and civil aviation...” [Translation]. (1948). Un acontecimiento sera 
el Congreso de Venereologia: Eminencias medicas de otros paises concurriran, ademas. Diario de Centro 
America. (April 15, 1948), p. 7. Pan American Sanitary Bureau. (1948). Expenditure Breakdown: Calendar 
Year 1948. PCSBI HSPI Archives, PAH0 0000568. Dr. Galich reported at this Congress that “trials or 
tests with penicillin are being conducted, up to now with the outstanding results, to prove conclusively 
that primary syphilis can be cured with only one ampoule or dose, just as is done in the United States 
seemingly with great success. [Translation]. (1948). Sistemas de Diagnostico al Congreso de Venereas. El 
Impartial. April 29, 1948. 
291 Aragon, H.A. (1948). Estudio de la sifilis y pruebas de la serologia en el Hospicio Nacional de Guatemala. 
Salubridady Asistencia 20:187-190. 
292 Ibid, p. 187. 
293 Levitan, S., et al., op cit., pp. 380-381. 
294 Ibid. (“By the time that 55 [children], called at random, had been checked, in addition to the 3 seropositive 
children, it was believed that a sufficient number of study cases had been assembled”) Thus, 34 children 
who had some sort of doubtful seropositive result were not examined further for clinical manifestations of 
syphilis. 
295 None of the 89 seroreactors exhibited obvious further clinical symptoms of syphilis during the observation 
period. In their study, the investigators concluded that the Kolmer and VDRL tests were best for routine 
use “under conditions such as exist in the region from which this group is drawn.” Levitan, S., et al., op 
cit., p. 387. Lumbar punctures at the time would have been considered standard of care for diagnosis of 
syphilis. The risks associated with such a lumbar puncture include a post-procedure headache, which 
may be accompanied by nausea, vomiting, and dizziness. The children also faced the risk of experiencing 
radiating back pain, serious bleeding, and rarely infectious meningitis or brainstem herniation from this 
procedure, though there was no documentation of adverse events. Mayo Clinic. (2010). Lumbar puncture 
(spinal tap) - Definition. Available at http://www.mayoclinic.com/health/lumbar-puncture/MY00982 
(accessed May 27, 2011). 
296 Stout, G.W., op cit., p. 239. 
297 Ibid. 
298 Cutler Documents. (1947-1948). Guatemala Journal Studies with the Military (GC). Clinical Notebook. 
PCSBI HSPI Archives, CTLR_0000620. 
299 John Cutler. (1955, February 24). Final Syphilis Report. PCSBI HSPI Archives, CTLR_0000704. 
300 Unsigned [John Cutler] on PASB letterhead to Richard Arnold. (1947, June 5). PCSBI HSPI Archives, 
CTLR 0001240; Levitan, S. et al., op cit., p. 379. Data analysis continued until the early 1950s. Stout, 
G.W., op cit. 
301 John Cutler. (1955, February 24). Final Syphilis Report. PCSBI HSPI Archives, CTLR_0000649. 
302 While the study results were published in 1952, the dates of the research are not clear. The VDRL team for 
this work also included Ramiro Galvez (a bacteriologist from the VDRL stationed in Georgia). Portnoy, J., 
et al. (1952). Op cit., pp. 566-70. 
303 Portnoy, J., et al., op cit. 
304 Ibid. 
179 
