“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
experiment in the Penitentiary was not included in the summary chronology 
in Dr. Cutler’s Final Syphilis Report. Dr. Cutler later wrote that the commer- 
cial sex workers were to be paid by the researchers for their services, 449 but no 
contemporaneous records document compensation. 
Dr. Cutler argued in his final report that “it became necessary to develop a 
different mode of attack” from the sexual intercourse exposure for inoculating 
the prisoners due to the small number of men available for the experiment 
and the scientific difficulties they were facing. 450 But researchers began intra- 
cutaneous inoculation of prisoners on May 14, 451 just days after the first failed 
“normal exposure” experiment. Prisoners were given intracutaneous injections 
of syphilitic material into the distal border of the foreskin and/or anterior 
aspect of the right forearm. 452 
The researchers achieved a 96. 8 -percent transmission rate in the first artificial 
inoculation prison experiment via injection. 453 But, “[i]n view of the impor- 
tance of gaining information as rapidly as possible,” the researchers decided 
to begin the next experiment “without waiting to determine the outcome” 
of the first. 454 The researchers also used the same needle “repeatedly” and 
“without sterilization of any kind from one patient to the next.” 455 The prac- 
tices significantly raised the risk of infection and other adverse health effects 
for individual subjects. 
The original plan to test orvus-mapharsen prophylaxis through the “normal 
exposure” of sexual intercourse between an infected woman and an unin- 
fected man in the Penitentiary was never implemented. 
Psychiatric Hospital 
In January 1947, four months before beginning any intentional exposure 
experiments in the Penitentiary, and a month before beginning intentional 
exposure experiments in the Guatemalan Army, Dr. Cutler advised Dr. 
Mahoney about supplementing the original research design to include 
experiments “such as inoculation” at the National Psychiatric Hospital of 
Guatemala. 456 The decision to undertake intentional exposure experiments 
there met with some resistance from Dr. Cutler’s supervisors, who raised 
concern about possible adverse public reaction. In April 1947, before any 
intentional syphilis exposure experiments began in either the Penitentiary or 
56 
