GUATEMALA EXPERIMENTS 1946-1948 
II 
method of inoculation involving damage to [the] mucous membrane in testing 
prophylaxis.” 513 Dr. Cutler responded to Dr. Mahoney’s concerns with assur- 
ance that “within the next few days we hope to have the prophylaxis study 
in syphilis under way as originally planned.” He concluded that “[w]e know 
nothing of infection following scarification, but it is my own feeling that we 
have underestimated the importance of the breaks in the continuity of the 
mucous membrane in the invasion of the spirochete.” 514 
However, by November, Dr. Cutler concluded that abrasion was “the only 
practicable method” of prophylaxis testing “approximating normal sexual 
exposure...” 515 When locally applying syphilitic material to the abraded 
mucous membrane of the penis: 
“[T]he foreskin was retracted and the glans placed on a stretch 
over the forefinger of the left hand of the physician. Using the 
long end of a 20 gauge, long-bevel hypodermic needle held in the 
right hand, the dorsal surface of the glans just distal to the coronal 
sulcus was lightly abraded over an area of about 2x5 mm. We 
tried to stop the abrasion short of drawing blood or serum, barely 
removing the surface layer, but not infrequently small bleeding 
points could be noted. The abraded area was covered with... [a] 
cotton pledget [soaked in Treponema pallidum ].” 516 
Dr. Cutler later reported that the researchers achieved a 91.6-percent trans- 
mission rate through this mode of inoculation, which was considerably greater 
than the rate following sexual intercourse. Dr. Cutler concluded that this 
method of inoculation should therefore “provide a most severe test of clinical 
efficacy of any prophylactic agent.” 517 
During a related mode of infection, the “multiple pressure technique”: 
“The inoculation was performed over the deltoid region... one or 
two drops of the spirochetal emulsion was allowed to drop on the 
surface. Through this drop, and using a sterile sewing needle or 
small-gauge hypodermic needle a series of 2-30 strokes was made 
by the technic [sic] utilized for smallpox vaccination and the mate- 
rial was allowed to dry. An attempt was made not to penetrate the 
dermis or to draw blood.” 518 
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