omason or meveieucoy FEDERAL SECURITY AGENCY U.S. PUBLIC HEALTH SERVICE NATIONAL INGTITUTE OF HEALTH BETHESDA 14, MARYLAND 17 Fesruary WAT Oy 2) Os Ouatenala City, Guatenala i &, Dear Doctor Cutler: We are sending you $00 0.3 gran (base) tablets of chlore- quine (SN-7618) (aralen) and if you should need an, additi 2 supply, 1, opel), by glad to mand it along. Sees Lilnalitree ret poled : The Bureau of Prisons has agreed to send you sone current Literature, T hope it has already gone, and to put you on the investigative work in that country that I find it hard to get down to work bere agsin. As Fred Brady would say, "I'm looking over the fence." Lil ti it) Se. (I cmcren Keach hr. Marlon) lad 7 | peccee— ei prorat ee Ezz ies theo) Vine peer ue Ce —October 26, 1948 The Director Pan American Sanitary Sureau P, Oy Box 4836 Washington 8, D. C. sirt It 4s respectfully requested that we te given instructions as to how to arrange the transfer to the Insane Asylum of the refrigerator, moving picture projector and plastic dinnerware that were ordered as a gift to the Insane Asylua in Guatemala in return for the cooperation of the patients, The suggestion has been made that the entire cost should be written off as professional services. Sincerely yours, John C. cutier Surgeon, USPHS Read and Approved: William J. Wcdnally, Jr. Chief, Caribbean Sector 30C/mmrFEDERAL SECURITY AGENCY E « U.S -PUBLIC HEALTH'SERVICE 7) (STATEN ISLAND, MEW YORK * verte ase eSanc NORATORY ce Oe Mata disquicting wevk-but. guess it will work oub alright. bit suprised at Joe's letter: andsone.of the statenentes and tia line ob reatentene 4 may be wrong but I believe that he was offered atthe lab. his dase pay plus & Per diem, you were to get 7 and he anc walker were to get 6. Tha 26% inerece in base ‘vane later as well os tre 7, ut iu herd to come com from the enexpected high but there’ are: other things: to consider. it probally will be guaged, by matter of principle rather than as a matter of money. hy-should a vivil service employee get 1600 to 2000 ‘More than the chief medical officer running the show? It places « premium on that status. I do not believs: he was given any asaurance that the income taxes would be Waived, maybe a bit of wishful thinking, and maybe sone have gotten by i: the pest by mot making an issue of it anc sending their forma to the, Baltimore office which hae a reputation of being more lenient with traveling government people of ali services. 4 would Tathor see Joe stup and think he will . have s good time and will have a chance ‘to-do sows important work in establishing the cardio test. cspecially since the spple cart has been upset by. the other nonspecifie reactions. ., . * : T an just woncenim: $f the mead is aon as grant for added odsts as he cleims,~ Is he trying tv:-kesp-sup and maybe outdo the Jones. gw much has he changed hig standard of living. Can-he' expect to spend 7 when he makes 7 and still wish to enve 2 to-S thousand « year. He made about 4400 here. Had travel expenss lunches amey, travel tine to work, maybe the work at home wag a bit heavier or eager for ‘the wife. Did He belong to the best ‘country olud hare, or lose 10 or sore at a game of ‘ice, (4f he is lucky he should break about even over # lon~ period playing with thé wane people) anda lot of other rather expensive luxuries. I am n ot ‘orie to deny you félke those things but is he trying to ,live on Mia nore) scale or d rather expanded exe that can't laat,when be retumme to the stages. I. thing the < hag deen pretty godd.tochim; he.bas eteadily risen from « Pl. nae PS qnd the next ‘step will be tn'the cards for him, Se has a job to do there and it isnot a of whether he-oan' do.it but wili-ne do it. Maybe a bit of retrenghing would ‘I'd hate to see him kill the goose that lays a golden ogg-nét so much lar and cents angle but fromthe copportunity viespoint. ‘I gatbered he wi ‘Twas theré but I-thamk the Boss tried tobe fai r for al} concerned: realize that yo shodld be: gétting more, but.the.wroug person; reinqd a agiak and fixed things up for all of “yo u." I-am just wongeying how you are makifg out from a financida “stancpoint. Sven though he hag. epuple or children, your expenses ‘are aout the same or’maybe you havo more.due-to official entertaining. A orcktail party is expensive. Your ear is an addedeost, too. 1 think yar standard’ of living Ts about the'same as in the states with tne usuel expected increase at First. You and Joo had somthing of « baffer, more so than Alice end Leigh. Do you think he a sane extra and how much?’ I am just wondering from @ pers~nal Joint. Joe will hear from Dr. & defo:e you can-anewer, but your thought "could be a on, If, foe inaists on coming back, we can get'a replacesent, of Tor any one ¢: but that’ just holds back progress for a while, and besides ho would lose ty a transfer back to the states for Itvang nas: not decrease, ¢ at all, intact it tus intrensed by 10 to 20%. A year of two should make, a bigger cifference in oodt of Tiving here and if he ‘cen save something wow or even break even, he will be better of by steying. Likewise he will sx v che Gppurtunity of coming up with a good piode of works I'd hate t¢ him come back because it would not do haim any good, regardless of what reason he would give, some would not believe it and he would be suscected of a lot of things. "People just! do not Like hove that give up the sponge qa:okly. 5 Wut te your opinion? Hope the Normal rabbite(N) in ears and 2 sypjilitic (8) arrived OK. The males should be OK for breeding purposes, or you could use them for strain purposes. More will follow. Tana bit, im fact more than a bit, leary of the experizent with laterthéVieane people. hey oan ‘not give consent, “do not know what 1s jgptidg onj and if Rouertooy organisation gov Win: Sf She woPlj'eisylwould Tales a lee oft eackes Tak the soldiors would be beat or the-prinoners for they can give eonsént. Maybe I'm too conservative. Alot depends on themedioal officer and thie reaction of the supt. of the ins. hosp. Also how many know what was going on, I fealize that a, pt oF a dozen could be infected, develop tho discase and. be cured bafore anything could bo suspected. the pontcillin could be kx for the insanity. your firet study could be done in a short time and none would be the wiser, In the repost, I see no reason to Way where the work was’ done and the. type of volunteer. You know ti tup best, Dut be sure thkt all angles have been covered. One ‘other sxperiment could be doustoo, the actual infection or attempt to infect the eye sith GC pus prom e pte or by the cultured organisms. It may: be possible that’ the eye is a relatively insensitive body and does not become infected easily, Maybe the Crede method is not necessary. Ie it uded theret In hospitals ‘and vy ‘tho local midwife? How much opthalmia is seom a year’. Just a thourht for the future. = ‘ . At a mosting in Wash. yesterday, the “rmy and Hayy people wanted to know’ more about tie Pro. Both want to use it but wo are holding back until wa got more data on GC. I feel pretty sure of the syphilis proteatton from the animal study. The treatment of ayphilis wax discussed and At nas more moore as Uauale “That heavy metal does no good I*11 accept but can't believe. tiat the total dose playa no part 1e .6 to 4/8 million are equally good, the method of administration does not matter, aqueoua or POB. That the time between doses dose not matter, ie, 2, ‘ give the same results. . I'll go ‘for the idea that ‘ined with’ good treatment in 4, 7, 8; or 14 days ry to treat pationte for longer tham one week, ‘maybe not more (than T eat't believe that good penicillin therapy will produce 25 to SOx . ie w{I] take acother year for theerrore to hecove evicent froma ‘tistical point.” Hell, -give me @ good clinicial and one will Jean more syphilis inva your that a inmidred’whpare, eookeyed, the reat te unprintable (~~ -) statisticians, When a patient after being tegative ‘for 8 wonths ‘happen ve a positive | Dlood test tre a cold, ie then classified as a failure, thes I'm sour on the whole numerical ‘busines ‘When & patient 1s sérono, tm all diagnostic tests including ‘the tinned ‘test used for quatitiation, and then the quantitative test is positive in 16 unite(Dil. of 1-4) thepatient 1s classified rorelapse, I think something ‘amells. Bran ‘Thomas roported-résults just like our 40X86. le uscd.2.4 on a 2 andS hour schedule ‘3 hours ys, 6.8% failure while the 2 hour gp’ 2%, Then he had 4.6 on the sane “réatine'S hdure. 8% '@ailure ad 2/houre was 1,9 %. .6-mil. Us gave SO% failure and 2.4 gavel0 after’ and 2 years. And them they" say that the total amount and title interval at not:important factors. Thomas was as a dae a wet hen. Also Sohoch of Yoxas, énd same of the other workers (Leifer). T'think the 40X35 report will be ready soon. Tbe Bogs said it whould be ic print rignt away Defore all this crap cones out, That ie an accelerated statement frok him. Gaually Be does not rush things. How is Leigh raking out? Working? and about the Malaria? Better keep this uncer the het for I am asking for. your oma. opinion of thy whys and wherefores. Tomay and Mrs Swanton. bave a, beby (g511) Born today. The greenhouse was opened today. The small pox.scare ie onusiig « lot of people to be vacciaatod, whor the vaccine is available, Marjie Cook 4s doing « good Seb on follow up, getting back sone of the olaer ratients. Had a letter from #6 Jaat week.Test in Cleveland M.Hosp. Will send information of the next takeoff ‘The S day Rx looks pretty god ao far. We ‘how. It uses: more penicillin but we are furnishing Faper ie short, hour ie lato, more later.-,negards to all. ‘Aa oversFEDERAL SECURITY AGENCY U.S. PUBLIC HEALTH SERVICE STATEN ISLANDANEW YORK ‘yoenou oso none LECRTORY June 50, 1947 Sr,Asst,Surgeon John C, Cutler Sanided Publica Sur 7, 15 Calle, Oriente Guatemala City, Guatemala Dear John: Your letter of June 22nd cane in today, We were all more than sorry to hear of Doctor Spoto's departure but we feel sure that he will be happier in the States under existing cir= We hope that we will be able to function with He seems to be a very nice person. ‘The question of income tax opens « matter in regard to which Iam rather helpless. We have asked sone friends in the . | Internal Revenue Department to give us the benefit of any good advice. Possibly they may have an “angle” through which some re= Lief from the tax burden may be effected. 111 be more than glad to make any adniniatrative move toward that end which is legally possible, In regard to the amount of gossip which the work in Guatemala hes’ engendered, we are doing our utmost here to re~ strict our own conversations and those of othere bearing upon the matter. we have also been aware of considerable converse. tion and disouseion being carried out in father high places, much of which bas not helped the work greatly. we ere forward- ing ell of your reports to Doctor Heller in @ way which we hope will prevent their being reed by unauthorized persons. 1 will write hin again in the matter, I hope that you will not hesitate to stop the exper- imental work in the event of there being en undue amount of in- terest in that phage of the study. it would be preferable to : delay. the work then to risk the development of an antagonistic atmosphere. We are anxiously awaiting your report of the transmis- sion experiments utilizing contact only. his is of vital in- portance if we are to carry out the stadies outlined, I have never mst Doctor Soper. ou will have to be guided by your own impressions as to freedom in discussing the Work, Ho 1a the responsible official of the study and as such 1s entitled to complete confidence,'sAsst,Surgeon Jobn , Cutler Tune 30, 1947 ‘The use of volunteer groups rather than the type which ig being employed would be more than satisfactory. our budget will stand for almost any fee for volunteers which you consider to be advisable, Doctor Arnold will take the necos~ sary steps to keep you supplied with animals. I will also ar range for the cuniculi material to be sent to you, We are erranging for a P-4 rating for Portnoy. Ke encountered the usual amount of delay in the matter but all appears to be in order at the moment. Singarely, a. ioy fal DirectorFEDERAL SECURITY AGENCY U.S, PUBLIC HEALTH SERVICE STATEN ISLANDSNEW YORK ven Use te nMTonY October 15, 1946 Sr, Asst. Surgeon J.C, Cutler PHS 2105 - APO 859 c/o Postaaster New Orleans, Louisiana Dear Jonn: We were more than glad to have your note of October 9th. The itene of heat controlling equipment which you mention are being purchased and we will forward then to you as soon possible, Botwoon the trucking trike and the maritine strike ‘the harbor of New York 1 still practically closed and we are unable to obtain any precise information as to when the acounu- lated cargo may be moved. We have contacted the Aray Transport Service in re-~ gard to employing that facility in moving freight to you. Wo were inforsed that the Army does not meintein a flying field in Guatemala which was contrary to ay impression, as I thought that the Air Corps had a field in Guetenela City. The army did have regular service fron Weet Paln Beach to Panama at a cost of 604 per pound . I wonder if you would check on the situa- tion and as to the possibility of moving material up fron Pana~ ma City to Guatemala City. Ve were all pleased to learn that Joe Spoto is return ing to Guatenale City. He oan hardly fail to be of real assist- ance to us a8 our work unfolds. I do not know of any man who could be more helpful inaLatin Anerican country than Joe. Your show is already attracting rather wide and favor able attention up here, We are frequently asked as to the progress of the work. Doctor T. B. Turner of Johns Hopkins wants us to check on the pathogenicty in man of the rabbit spiroch Doctor Neurath of Duke would like to have us follow patients with his verification procedure; Doctor Parran and probebly Doctor Moore might drop in for a visit after the first of the year. We have told them all that the laboratory is not completed as yet Dut when in operation we would more than welcome vieitors end in- spection, Sincerely yours, . (petty ediddl Director USPHS eM: towSeptember 20, 1947 John ¥, Mahoney, Medical Director Direotor, Y. D. Research Laboratory 0. 8. Marine Hospital Staten Island 4, New York Dear Dr. Nehoney1 I fee] tonight just as I felt when the nevs cone of the decision to disceatinue the Terre Haute project, although the blev is harder now than theh, for we have | mach more at ateke and we have highly sugzertive evidence to make us believe that we are on the right track vith respect to prophylaxis, or as your letter of September 18 anticipated ve shall, unless arrangements can be mate, be Pékced vith the dissole- ‘ion of our staff which, under the circumstances is justified. Foie morning at 7 A.M., juat after Z had returned fron seeing our next goamrrhea study group at the Base Militar end froe depositing the last report to you in the APO, for security reasons, I sav vith Sacha all of the 130 patients on vhom ve are doing syphilis studies. ‘his vas an exciting experience: all of the vouen inoculated Wy multiple pressure (smallpox technique) mé receiving proplylaxis shoved n0 evidence of infection in contrast to controle all of vhom shoved physical evidence of take. Moat of the aales vho bed bad a 2x2 ma superficial abrasion ef the penis and applice- tion of material showed papule formation or ulceration (still Darkfield negative) vatle those similarly expored and given prophylaxis showed nothing. Ve left then and —asveabled vith the group feeling extlarsted as though we might have the method of preof.; Atd then the staff aade plana to repeat the method on Sunday along vith several other techniques, feeling as though we had hopes of success. A little later we completed arrangements to take the inoculated girls, the first of whoa bas begun te shov serclogic evidence of syphilis, to begin studies on traa- emission via normal route, We felt as though at last ve were getting stmevhere, This afternoon ve received your letter ands similar note fron Dr. Keller watah pretty much blasted our hopes, The merale cf ail of the services here has been very low for the tu living allovinces, but wtth' the neva of cute for Xr. Walker the xerale of our group hit bottom, But all fool the need of seeing thyvagh vhat has been started. If ve quit all nev work as of now Dr, Leviten and Xr, Portney wad Miss Walker vill stay four more months to complete the vork that is now under vay, But it gives us all,along vith ocr die- —couragenent at the scientific loss ve may suffer, a very eapty fealing te ShAlise that the U, 8, Governaent has ao responsibility vhatdoever with respect to any comeituents nade to ite ovn personnel, or, 8 vo have seea, oven vith respect to comitaente vith foreign goveraneats, You and ‘Dr, Heller and the others have done all in your power to | protect your people and to carry oat your promises, but the lav 1s the lav and changes = +; fhe roles trom day to day and has no respect fer the effort or proaise of those de \Ylenated os ite agents,-2- You have invested in this project years of work and research from yourself and your staff, and before ve have fintehed, more than $50,000 vill have been spent to bring us to the point at which ve nov find ourselves, the point at which we think that we shall be able to begin to make real contribution. And now, Decmuse of the decision of men vho have no real knovledge or understanding of con- Aitions o work here ve shall be forced to stop for lack of personnel. I shall stay, for vith the $100 additional pay end the promotion (if it is approved) ay salary vill be essentially unchanged, and I have no family concerned. Dr. Levitan connot afford to vtay long even though there is nothing in the worlé that he vould rather do, for it 1s finencielly impossible. Mr. Portnoy cannot afford to keep his family hero any longer than the four months necessary to complete our syphilis «| studies undervay. Ao you intimate 1t vill be ifficult to secure replacement. With the cost of moving and getting settled here; and vith the rising costs of living I could not, either, in good faith, recomnend to any officer or civil service emleyes t0 cone. A single man might bresk even, but it would cost him considerably mors, than the cost of quarters and board in a Marine Hospital. A married aga with children would be foolish to leave the States to come here under these eiméemhtancer, Aside from the consideration with respect to the financial aspect, any one coning would re- quire a period of three to four months to learn enough Bpenieh to be of mech help medically. Resides that I doubt: very much thnt the service has many men of the calibre of our group who conld be sent here, And to take tege of our eppertu- Bities ve should have only men of that type who are wrapped fp in the problem and who are villing to work as our crev here acv, from 5:00 4.M. on through midnight Af needed, seven days por week, for weeks on ond. We have actentific opportunities vhich cons only rarely, but in order to take EZ adusnte we need competent people, and competent people, aleo have to pay the costs ef living required here, and cannot do the best work if they are under financial Arfioulties, TN , as the coaritter nrobably thought, thet the cost of liv ing in the States is rising, Dut the cost of living here when ve enme vas at least the equal of what it nov is in the Stoter, and the rise in costs ther is reflected here, 1f not magnified. At the degining we bad the advantage of being able to get ——some foot for aur group fron the Army Gonmishry, but that opportunity is nov nea- ‘existent except for an oscastenal purchase of $2 or #3. ven the Army perscunel here, vho also had cuts, have not been able to get commieary supplies in amounts to help, so that the enlisted nen are nov having to saad home the vives. It is ‘Aaericans at home,for there hare equivalent to those .at ¥ which ve are accustomed, It should be understand that none of us has significantly changed standarde or mods of living. As I pointed out, Hise and I can stay, but to tllustrate the representative costa here I ahall itemize the costete keep my house. Heat - $90.00; stove wood $20.00; Blestric b111 $10.00, 1 servant 415.00 (Wiese does her evn cocking and washing); gardener $10.00, grocery bill $20 fo $20.00 (without including cost ef say 1iquours ond in addition to the store of food bought earlier which caanot be replaced); meat $15; Spanish lesstas #12; PX $15; dry cleaning $10; (1.00 for a éress or suit); milk $5; market $20 (fresh vegetables) paper $1; garbage collector $ 2.60are fixed expens: such as $88 par year for suto insurance, $65 for earthquake fire and theft and whaterver ve order for the safety of the household, Olothing, of course is not included, in spite of the rapid deterioration from leundrg and mildew. ‘The Portaoy's pay a little less rent, dut pay almost $100 more for food, more for servants, $20.00 per month for tuition for Barry, ete. Joe Pelongs to no clubs now and has out out all reoreational expi rizht here Just to 11 be the thought in Washington that servante and ulce hones are iuxuri houses cannot De run without st least one servant, and none of us ts willing te 11 in a cheap house here, for even our evn furaiture would not fit, anf they are complet ly united for Anerican standards of living. Yor this you can understend viy the group cannot afford to stay, for these figures giveisome idea of cos After this very freuk unvurdening of my theucht I should like to paopose severa! possibilities for getting Around the problen, It was xy understanding that Mr. Port- ‘Noy and Miss Welker were given leave of absence froa Civil Service and are nov employ of Pan dmerican Sanitary Buresa, an international hoalth agency not subject to rules of U. 8, Governsent, It was further wy understanding that federal funds given as greats in aid have no strings attached so that the Pen anofican Sanitary Sirem can poy vbatever it deens proper its ova employees. For thelr reasons I cannot sec why Mr, Portnoy eat Nive Walker shold cone unter the jurisdiction of on executive order qutting living allovances. Tho Institute of Inter-American affairs hat had no euch oat in Living allowance, If that should be the case whey could not the commissioned offhcers de given leave of absence without pay ant be put on the Pan /merican Sanitary Burean payroll at a salary and living allowances equivalent te vhat was origizally Getting? It was my unterstending that you had been told that y assignasnt of funds fo Pan American Sanitary Burem you vould have Jurisdiction over and fresdom of use of funds not alloved ty federal accounting practices and shat personnel on leave to Pan dmerican Sanitary Bureau would be handled ty Pen Anericen Sanitery Burean and net according to Civil Service ruling since they vare no longer civil eervice, Yer that reason I am wach purcled at the turn of events. I sincerely hope thet you will be able to find a vay to keap the group together, for I think that the YDHL ts on the track of tremendously taportant fundavental in- formation, and if we have to breek in a complete new staff we shall find ourselves only a little Ut advanced in movledge beyond that point at which they whall be four months from now when the studies now underway have been completed. Sincerely, John 0, Cutler Surgeon, USPHE