Juan María Funes (30 May 1907 - 23 August 1984) was a Guatemalan physician and surgeon who specialized in the diagnosis and treatment of sexually transmitted diseases (STDs). He studied at the Faculty of Medical Sciences of the National University of Guatemala, currently the University of San Carlos of Guatemala, and for his graduation thesis he conducted a study on female genital prolapse in the San Juan de Dios General Hospital. Within his specialty, he worked as a health administrator and researcher for the Ministry of Public Health and Social Assistance of Guatemala, the World Health Organization (WHO), and the United States Public Health Service (USPHS).
In 1945, while working at the Venereal Disease Research Laboratory in Staten Island, New York, he suggested to his American colleagues to conduct research on STDs in Guatemala, and subsequently he was one of the Guatemalan medical doctors involved in the experiments on sexually transmitted diseases performed in that country with human beings between 1946 and 1948, and directed by the American surgeon John Charles Cutler. Based on the results of these experiments, between 1949 and 1953 he published three articles in the Bulletin of the Pan-American Sanitary Bureau, currently the Pan-American Health Organization (PAHO), and in 1962 he co-founded the Guatemalan Academy of Dermatology, Syphilology and Leprology.
Biography Juan María Funes Fonseca was born in Guatemala City on May 29 or 30, 1907. He studied at the Faculty of Medical Sciences of the National University of Guatemala, currently the University of San Carlos of Guatemala, where he graduated in 1938 with a thesis titled Algunas consideraciones sobre la etiopatogenia y el tratamiento quirúrgico del prolapso genital, in which he described the causes of uterine prolapse in Guatemalan women and the surgical treatments that were practiced in the 1930s, in the Gynaecology Service of the San Juan de Dios General Hospital, under the direction of the prominent physician Mario José Wunderlich.Funes, 1938, p. 22 In the conclusions of his thesis, Funes indicated that uterine prolapse was quite frequent in Guatemala due to the anomalous conditions in which childbirth took place in rural areas of the country; that vaginal hysterectomy using the Charles Horace Mayo technique was the most effective surgical treatment for treating it in certain age groups; and, that the position of titular midwife should be established in Guatemala, at least in each departmental capital.Funes, 1938, p. 24
During the government of Juan José Arévalo (1945–1951), Funes was the Head of the Venereology Section and Director of the Venereal Disease and Sexual Prophylaxis HospitalPCSBI, 2011, pp. 29, 37, 113CPEEPHG, 2011, p. 38 both divisions of the Ministry of Public Health and Social Assistance of Guatemala. Around 1950, he became Vice-Chairman of the World Health Organization's Syphilis Study Commission, and in 1954 he directed the National Anti-Venereal Campaign of Guatemala.PCSBI, 2011, p. 88 From 1948 to 1956, he served as Special Consultant with the Venereal Disease Division, Bureau of State Services, USPHS,PCSBI, 2011, pp. 88, 113 and in 1962, together with physicians Mariano Castillo and Rodrigo Sánchez, he founded the Guatemalan Academy of Dermatology, Syphilology and Leprology,Cordero and Caceres de Mansilla, 1980 currently the Guatemalan Academy of Dermatology.
Juan María Funes died in Guatemala City on August 23, 1984, at the age of 77.
Involvement in STD experiments conducted in Guatemala Background In 1938, the surgeon general of the United States and operational head of the Public Health Service, Thomas Parran, declared before the U.S. Congress his support for increased funding and scientific research for public health, and the investment of personnel and resources to conduct specific research to develop more effective methods of prevention, treatment and control of sexually transmitted diseases than those available at the time, since the available methods were more than 30 years old, their effectiveness was uneven and their application cumbersome.PCSBI, 2011, pp. 11, 12, 16, 22, 23
When World War II began in 1939, U.S. scientists, physicians and public health officials determined that there was an urgent need to develop better treatments to cure the STDs that would affect in troops during wartime, and expected up to 350,000 new gonorrhea infections per year, which would cause 7 million man-days lost, or the equivalent of losing the total strength of a year's worth of two military divisions or ten aircraft carriers, with a treatment cost of USD34 million,PCSBI, 2011, pp. 12, 14, 15 which is approximately USD770 million in 2024. That is, STDs were not only a public health problem in the United States, but also a threat to its national defense. Therefore, the Franklin D. Roosevelt administration, through the Committee on Medical Research of the Office of Scientific Research and Development, quickly allocated federal funds to mitigate that threat, giving medical specialists an unprecedented opportunity to conduct research aimed at reducing the harm caused by STDs to the armed forces and the general U.S. population.
In that context, Dr. Joseph Moore, head of the Subcommittee on Venereal Diseases of the U.S. National Research Committee and head of the Division of Venereal Diseases at Johns Hopkins University,PCSBI, 2011, pp. 12, 13 approved the conduct of experimental research with volunteer, risk-informed human subjects,PCSBI, 2011, pp. 14-16 with the ultimate objective of finding a more effective prophylaxis to treat STDs. Although the problem of ethical and legal authorization of intentional exposure of human beings to such diseases remained unresolved,PCSBI, 2011, p. 16 the research was conducted between 1943 and 1944 at the Terre Haute Penitentiary in Indiana. It was directed by the head of the Venereal Disease Research Laboratory, Dr. John F. Mahoney, from its headquarters in Staten Island, New York, and carried out at the penitentiary by Dr. John Cutler and Dr. Henrik BlumPCSBI, 2011, p. 20 along with their technical staff. However, ten months after its inception, the research would be terminated in July 1944 by Mahoney's order because the researchers failed to induce, through artificial inoculation, a gonorrhea infection in the volunteers with the regularity necessary for the experimental methodical application of prophylactic agents.PCSBI, 2011, pp. 21, 22 Subsequently, Drs. Mahoney, Cutler and others published the results of the experiments in January 1946, at about the same time that plans for research in Guatemala were being developed.PCSBI, 2011, p. 23
Experimental research carried out between 1946 and 1948 In his writings, Cutler indicated that the idea of conducting research in Guatemala was proposed by Dr. Juan Funes in 1945, when he was working at the Venereal Disease Research Laboratory in Staten Island, New York, on a fellowship from the U.S. Office of Inter-American Affairs.PCSBI, 2011, pp. 28, 37 According to Cutler, Dr. Funes had pointed out to him and other American colleagues that prostitution was legal in Guatemala, and that sex workers were required to undergo regular health inspections at the Sexual Prophylaxis Dispensary, which was attached to the Venereal Diseases HospitalCPEEPHG, 2011, p. 45; PCSBI, 2011, p. 45 located in Guatemala City and directed by him, which was a circumstance that Cutler believed offered an excellent opportunity to conduct experimental STD research with human subjects.CPEEPHG, 2011, p. 45; PCSBI, 2011, pp. 28, 29, 45
Once Funes' idea attracted the attention of Dr. Mahoney and other U.S. medical authorities, it became a formal research project with a design similar to that of the Terre Haute research.PCSBI, 2011, p. 13 It would be carried out with funds from the Venereal Disease Research Laboratory transferred to the Pan American Sanitary Bureau, which would be implemented in Guatemala by Cutler and his team, with whom Funes would collaborate as a researcher and liaison with Guatemalan medical authorities, such as Dr. Luis Galich, who by then was the head of the General Directorate of Public Health.In August 1946, the Venereal Diseases Training and Research Center, created through a cooperation agreement between the General Directorate of Public Health of Guatemala and the Pan American Sanitary Bureau, began operating in Guatemala City.Funes, 1949, p. 47; CPEEPHG, 2011, p. 36 It would function specifically as a serology training and research center, and also as a center for the research of bacterial pathogens that cause STDs. Later that year, the research would begin in November 1946, it would consist of a serology study and a series of experiments with human subjects, and would end two years later, in December 1948.
The serology study was conducted with the main objective of improving methods of diagnosis of syphilis in Guatemala by testing the effectiveness of specific blood tests, and detecting antibodies to that disease in different human groups in the country.PCSBI, 2011, p. 6 For their part, the experiments consisted of controlled inoculation of adult humans with syphilis, gonorrhea and chancroid to methodically produce artificially and sexually induced infections on a regular basis, so that researchers could carefully observe both the development of such diseases in the human body and the effect that the proven drugs, such as sulfathiazole and argyrol, had on them, in conjunction with penicillin, which was the most advanced treatment of the time, and whose effectiveness and methods of application were being tested and developed. All of this was done with the same ultimate objective as the Terre Haute research, which was to find a more effective prophylaxis to treat STDs.
The serology study included in Guatemala City, soldiers of Brigada Guardia de Honor (Honor Guard Brigade), inmates of Penitenciaría Central (Central Penitentiary), patients of the Hospital Neuropsiquiátrico (Neuropsychiatric Hospital), children of Hospicio Nacional (National Hospice), and patients of Leprocomio La Piedad (La Piedad Leprosy Hospital). It also included public school children of Puerto de San José (San José Port) on the south coast of Guatemala, and personnel of the U.S. Air Force stationed in the same locality. The STD experiments included soldiers, prisoners, psychiatric patients and sex workers, exclusively Guatemalan, and the artificial methods with which they were inoculated included the injection of pathogens directly into different parts of the body, and the manual application of infected exudates directly into the urethra and cervix, and into superficial wounds caused by abrasion or scarification of the skin.PCSBI, 2011, p. 185) Sexual inoculation was done through intercourse between men and sick sex workers, some as a result of their work, and others artificially inoculated previously by the researchers themselves.PCSBI, 2011, pp. 46, 55
Dr. Juan María Funes participated in both the serology study and the human subjects experiments for their duration and subsequent follow-up studyCPEEPHG, 2011, p. 68; PCSBI, 2011, p. 113 on a paid basis.CPEEPHG, 2011, p. 84PCSBI, 2011, pp. 176, 195 His performance was so satisfactory, that Mahoney declared in a letter to Cutler his support to make Funes the leading syphilologist in Central America,PCSBI, 2011, p. 83 which potentially offered him very good opportunities for professional development. During the research, Dr. Funes applied the knowledge he learned in the United States and was able to experiment scientifically with human beings,Funes, 1949, p. 50 who were poor, illiterate and from marginalized communities, without development opportunities and vulnerable to abuse, who, moreover, did not receive any humanitarian benefit proportional to the harm inflicted on them,PCSBI, 2011, pp. 100, 101 which, in some cases, was deliberately and severely intensified.PCSBI, 2011, p. 108