First, do no harm.
In litigation, some try to treat history as a science. But in the hands of most people, it's not, even if it involves medicine. Telling or teaching history depends on perspective, judgment, and extensive knowledge of then-extant practices and facts. Then the story-teller must choose which facts to present in the allotted time and/or space. For an example, consider the telling the history of John Charles Cutler, M.D., a man who ended up as Assistant Surgeon General in 1958.
Dr. Cutler died in 2003. At that time, a newspaper reporter wrote the following glowing story of a beloved professor:
Obituary: John Charles Cutler / Pioneer in preventing sexual diseases
Wednesday, February 12, 2003
By Jan Ackerman, Post-Gazette Staff Writer
Long before AIDS became an international health problem, Dr. John Charles Cutler led the way in trying to prevent and control sexually transmitted diseases around the world.
Dr. Cutler, a former assistant surgeon general of the U.S. Public Health Service, was part of a group that in 1944 worked out the ways penicillin could be used to treat syphilis.
As one of the founders of the Family Health Council of Western Pennsylvania in 1971, he worked tirelessly to find better ways to provide affordable reproductive health-care services to women who need them.
"He thought every person should have access to these services, regardless of income," said Richard Baird, acting president of the Family Health Council.
"To him, health was more than simply studying microbes. It was life," said Ravi Sharma, professor of demography at the University of Pittsburgh Graduate School of Public Health.
Sharma said Dr. Cutler looked at the study of health in a "holistic" fashion, relating it to social, political, economic and cultural customs.
"He was a pioneer who had firsthand experiences of living and working in the Third World," he said.
Dr. Cutler, of Point Breeze, a retired professor at Pitt's Graduate School of Public Health, died Saturday at West Penn Hospital of pneumonia following a heart attack. He was 87.
His wife of 60 years, Eliese S. Cutler, said he was modest about his personal accomplishments but resolute in his mission.
Interviewed in 1988, Dr. Cutler told a reporter for The Pittsburgh Press that the AIDS problem was a replay of venereal disease scenarios of bygone years.
"The control of AIDS will come only when there's a shift from a preachy, moral approach to a medical viewpoint," he said.
"The kind of education that worked during World War II is needed again. The military services provided education about venereal disease and backed it up with making condoms and prophylaxis kits readily available."
Dr. Cutler was born and raised in Cleveland and graduated from Western Reserve University Medical School in 1941 with a Phi Beta Kappa key. In 1942, he joined the Public Health Service as a commissioned officer and remained active until 1967. During World War II, he was a medical officer on convoy duty in the Coast Guard.
His interest in the prevention and control of sexually transmitted diseases began in 1943 when he worked as a medical officer in the U.S. Public Health Venereal Disease Research Laboratory in Staten Island, N.Y. That led to his appointment to head a venereal disease research program for the Pan American Sanitary Bureau in Guatemala in 1948.
In 1949, the World Health Organization asked him to lead a venereal disease demonstration program for Southeast Asia that was based in India, which had won its independence from the British crown in 1947.
"There were 80 Americans in all of India," said Dr. Cutler's wife, who accompanied him there and to other international posts. She said her husband was always proud that he was able to raise the Indian flag in Simla, India, after the independence.
After returning to the States in 1950, Dr. Cutler continued to rise in rank until he became assistant surgeon general of the U.S. Public Health Service in 1958.
In 1960, he worked for the Allegheny County Health Department, organizing the final polio vaccination program in the Hill District. From 1961 to 1967, he was an assistant and then deputy director of what later became the Pan American Health Organization in Washington, D.C.
He returned to Pittsburgh for good in 1967 when he was recruited as professor of international health to head the population division in the Graduate School of Public Health at Pitt. In that post, Dr. Cutler was instrumental in getting funds for a major international health project in West Africa. With federal funding, he organized a program that enabled obstetricians and gynecologists from Third World countries to come to the United States for training in reproductive health technology.
He served as chairman of Pitt's department of health administration and was acting dean of the Graduate School of Public Health in 1968 and 1969.
Dr. Gordon MacLeod, professor of health policy and management at the graduate school, said Dr. Cutler had continued to return to the school on a weekly basis until a few weeks ago.
"He was a much beloved professor, both at the graduate school [of Public Health] and at the Graduate School of Public and International Affairs," MacLeod said.
In addition to his wife, Dr. Cutler is survived by a sister, Elizabeth Cobb of Manson, Wash.
Friends will be received at John A. Freyvogel Sons Funeral Home, 4900 Centre Ave. at Devonshire Street, Shadyside, from 7 to 9 p.m. today and one hour prior to an 11 a.m. memorial service tomorrow.
The reporter missed some facts, which at that time were buried. Here's today's Wikipedia entry for Dr. Cutler:
John Charles Cutler, M.D. (June 29, 1915 – February 8, 2003) was a senior surgeon, and the acting chief of the venereal disease program in the United States Public Health Service. He was involved in several controversial and unethical medical experiments regarding syphilis, including in Guatemala and the Tuskegee syphilis experiment.
Cutler was born on June 29, 1915 in Cleveland, Ohio, to Grace Amanda Allen and Glenn Allen Cutler.
He graduated from Western Reserve University Medical School in 1941, and joined the Public Health Service in 1942. In 1943 he worked as a medical officer in the U.S. Public Health Venereal Disease Research Laboratory on Staten Island.
Cutler oversaw the syphilis experiments in Guatemala in the 1940s, during which doctors deliberately infected an estimated 1500 Guatemalans, including orphans as young as nine, soldiers, prisoners and mental patients with syphilis without the informed consent of the subjects. This study not only violated the hippocratic oath but it echoed Nazi crimes exposed around the same time at the Nuremberg trials.
In 1954, Cutler was in charge of experiments at Sing Sing prison to see if a vaccine made from the killed syphilis bacterium, would protect prisoners against infection when he later exposed them to the bacterium. Those infected were later treated with penicillin.
Cutler became assistant surgeon general in 1958.
In the 1960s, Cutler was involved in the ongoing Tuskegee syphilis experiment, during which several hundred African-American men who had contracted syphilis were observed, but left untreated.
In “The Deadly Deception”, the 1993 Nova documentary about the Tuskegee experiments, Cutler states, “It was important that they were supposedly untreated, and it would be undesirable to go ahead and use large amounts of penicillin to treat the disease, because you’d interfere with the study.”
In 1967 Cutler was appointed professor of international health at the University of Pittsburgh, where he also served as chairman of the department of health administration and acting dean of the Graduate School of Public Health in 1968–1969. He died on February 8, 2003 at Western Pennsylvania Hospital inPittsburgh.
Now, even more of Dr. Cutler's history is being told as a US Presidential Commission discloses - and apologizes for - his human experimentation. The NYT includes this AP story. The commission's website is here.
The AP story includes the following excerpts illustrating the vast gulf between practices in the "civilized" worlds of the past and today:
"[The commission] revealed that some of the experiments were more shocking than was previously known.
For example, seven women with epilepsy, who were housed at Guatemala's Asilo de Alienados (Home for the Insane), were injected with syphilis below the back of the skull, a risky procedure. The researchers thought the new infection might somehow help cure epilepsy. The women each got bacterial meningitis, probably as a result of the unsterile injections, but were treated.
Perhaps the most disturbing details involved a female syphilis patient with an undisclosed terminal illness. The researchers, curious to see the impact of an additional infection, infected her with gonorrhea in her eyes and elsewhere. Six months later she died.
Dr. Amy Gutmann, head of the commission, described the case as "chillingly egregious."
During that time, other researchers were also using people as human guinea pigs, in some cases infecting them with illnesses. Studies weren't as regulated then, and the planning-on-the-fly feel of Cutler's work was not unique, some experts have noted.
But panel members concluded that the Guatemala research was bad even by the standards of the time. They compared the work to a 1943 experiment by Cutler and others in which prison inmates were infected with gonorrhea in Terre Haute, Ind. The inmates were volunteers who were told what was involved in the study and gave their consent. The Guatemalan participants — or many of them — received no such explanations and did not give informed consent, the commission said."
Today, there's little or no excuse for ignorance of facts because we have the Internet - the world's great access point. For example, care to see Dr. Cutler's work? Go here to the National Archives page with images of his papers. One can read here his 1947 correspondence.
As to changes in standards, consider an additional fact. The papers tell us and show us that the then-sitting Surgeon General was most interested in Dr. Cutler's work. And, according to this article, the papers include the following statement attributed to then Surgeon General Thomas Parran: “’You know, we couldn’t do such an experiment in this country.” (citing G. Robert Coatney to Cutler, February 17, 1947, Box 1, Folder 17, Cutler Papers.)
Conclusion? Ask lots of questions when investigating the past, and do not take anything for granted.