[Department of Health and Human Services. USA. CDC] [A Centers for Disease Control Production] [In cooperation with American Society of Tropical Medicine and Hygiene] [Workers in Tropical Medicine] [J. Austin Kerr, M.D., Rockefeller Foundation, Retired, April 1981] [Interviewed by: Wilbur G. Downs, M.D. Clinical Professor of Epidemiology, Yale Arbovirus Research Unit] [and Thomas H. G. Aitken, Ph.D. Senior Research Assoc. Epidemiology. Yale Arbovirus Research Unit] Aitken: Austin, your professional life with the Rockefeller Foundation started shortly after you left medical school when you were assigned to your first post in 1925, I believe it was, in Alabama. [slide reads Thomas H. G. Aitken, PhD] What were you sent down there to do? Kerr: Well, this was a training station, really, for the Rockefeller Foundation candidate staff members. [J. Austin Kerr, M.D.] [Field Training Station International Health Board, Rockefeller Foundation, Andalusia, Alabama 1925.] When I reported for duty in Andalusia, I found that I had been preceded by a classmate of mine at Northwestern, Dr. E.R. Rickard, who had begun work with the Foundation a few months before I had, quite independent of my interests. Rickard and I went up to Tennessee and started our work in the mountains of eastern Tennessee, based in Gatlinburg. We collected stool samples from schoolchildren and examined them for hookworm eggs in a primitive little laboratory we that had set up in the county health office. We found plenty of hookworm skin in the children there. That corrolated with the sandy soil of that country which was derived from the erosion of the sandstone rocks of the high mountains. When we finished our work in Andalusia, we moved to what's known as the central plateau of Tennessee, which was west of Knoxville, where we found the soil was clay and the doctors they--the doctor in charge of the [mental?] health unit there and the other doctors--there was no hookworm there. [E larvae?] could not survive in the very fine grain clay soil. So we broke up. I went back to Andalusia and Rickard continued on several other places in Tennessee. And we evenually published a brief short paper on this, our study, which didn't contain anything that hadn't been known before, but which was of interest to the Tennessee health authorities. [Slide of published article "The Incidence and Intensity of Hookworm Infestation in the Various Soil Provinces of Tennessee"] Not very long after that I was tapped to go to Brazil as the aide-de-camp of Joseph H. White, who was one of the old yellow fever workers in the United States Public Health Service. His most important work was in the control of the New Orleans epidemic of yellow fever in 1906. He had been the Foundation's principal advisor on the yellow fever contol program that it had started in the Americas, and had worked in Brazil on previous tours of duty. We went by boat to Brazil--14 days on the water--a nice time for rest, and landed at Rio de Janeiro, and then proceeded north to Salvador, the capitol of the state of Bahia, where Dr. White had his headquarters for the yellow fever service in the country. Aitken: What did the work in Salvador consist of? Kerr: This was the standard yellow fever control operations, which involved the division of the whole urban area into zones of such size that one man, who would be called an inspector in this country, but in Brazil that was a rather high title, and they were known in Brazil as guardas, which is obviously the same as "guard." [Guarda] Each of these guardas had a zone of such size that he could examine all the domestic water supplies and all the houses in the zone once a week, and eliminate those which pour out the water from those which contained Aedes aegypti larvae. There were additional personnel that took care of sealing--I should say moquito-proofing--larger containers of water. The water supply in the city, as well as in many other places, even in Rio de Janeiro, was intermittent, and so there were water storage tanks in each house, and these either had to be either sealed to prevent mosquitos from getting into them or inspected carefully, quickly. At this time, the inspections had to be made at weekly intervals because the life cycle of those moquitos in those hot tropical country was completed in 8 or 9 days, [Life Cycle of Aedes aegypti] and if the interval was at two weeks, a whole generation of mosquitos could breed and mature and fly off wherever they wanted to between visits. Aitken: Could I interrupt a minute to ask why were you doing this Aedes aegypti control work in Bahia? Kerr: Well, this was not only in Bahia, it was in all of Northern Brazil, which had endemic yellow fever, which became known in periodic outbreaks in the area. Aitken: But only in the cities, is that right? Kerr: Oh, no. It was in the towns and villages in the interior. I was assigned to work in the state of Paraiba de Norte in northeast Brazil, which was a small state in northeast Brazil, which extended from the Atlantic Ocean back inland into the semi-arid country inland. The service had been going on there for some time and it was quite a modest effort. There were six employees (six guardas): a foreman, and a driver, and a couple of servants. This was my crew, so to speak. [1927, image of guardas] This was in 1927. When I was there I obtained a picture of the crew, the personnel, that had been in charge of the yellow fever eradication operations, cause that's they had called it in 1924, which totaled 55 people. [image of the 55 yellow fever personnel] Aitken: Then there was the death of Paul Lewis in Salvador. Kerr: Yes, Paul Lewis was a visitor, a bacteriologist, from Rockefeller Institute in Princeton who was on a short tour of duty in Brazil. He had developed a classical case of yellow fever which took him off in a few days. He was working at the Yellow Fever Laboratory which had been established in Salvador during my absence in Paraguay. The director of this was Nelson C. Davis, who was a remarkable man, really, very hard working, very able, and doing excellent work in isolating yellow fever virus, or attempting to, in Rhesus monkeys, which were available (imported from India), which was the only known susceptible animal. [Photo of Nelson C. Davis, Brazil 1930] There had been developed in the Foundation laboratories in New York, a so-called yellow fever protection test using the Rhesus monkey. [Slide reading Yellow Fever Protection Test. Yellow Fever Virus. Rhesus Monkey. Convalescent Serum] The protection test was simply a mixing of yellow fever virus, which had been isolated shortly before, with serum from a recovered case of suspect yellow fever. And if the monkey survived, it was taken as proof that the serum contains yellow fever antibodies. And if the monkey died of the yellow fever, that person had not had yellow fever. A very expensive and cumbersome test. The handling of the material from these monkeys, Dr. Davis had recovered from yellow fever, a mild attack, and I had a very mild attack. Aitken: Were there other yellow fever casualties? Kerr: There were plenty of casualties. That's the way it was in those days. Aitken: So when Paul Lewis died do I understand you proposed to the Foundation that you go up. . . Kerr: No, I didn't propose, I was told Aitken: You were just sent there. . . Kerr: I was all set to go home on leave, and I got on a boat which stopped in Salvador. I got off and the casket containing the remains of Paul Lewis was sent on. Aitken: And you remained. Kerr: I remained. Aitken: Ray Shannon was there. [Image of Raymond C. Shannon. Salvador. Bahia. Brazil. 1929] Kerr: Shannon was there, yes Aitken: Cause he'd been working with Nelson Davis. Kerr: Yes, he was in charge of the entomological end. His main job was to provide a stready supply of Aedes aegypti to be fed on suspect cases and then brought back to the laboratory and fed Aitken: Oh I see. Xenodiagnosis, so to speak. [Xenodiagnosis] Kerr: Yes. Aitken: How long did you remain in Salvador? Wasn't this just before your African assignment? Kerr: Yes, only the last few months of my tour of duty. Aitken: How is it that they happened to send you off to West Africa? Kerr: Cause they needed somebody in the laboratory there who was immune to yellow fever. [laughter] Aitken: Who was in charge of the lab out there? This was in Lagos, wasn't it? Kerr: Yes, Lagos. I became the entomologist. Aitken: That's when you started your mosquito transmission studies, with culex [tholaxius?], I believe. You transmitted the virus. That's the only culex which has been associated with yellow fever transmission, laboratory vector. Kerr: Well, I believe there were no flaws in the transmission experiment. It was a saltwater breeding [team?]. Bred in brackish water ponds along the coast. Aitken: What prompted you to select this species? Kerr: Because I was studying the mosquito [?] of a bitten man by making collections of human bait from late twilight and early night, I forget the exact hour, and this species turned up in a lot of these catches, biting man. They were of interest, along with a lot of other mosquitos which were much more abundant then they, and might [fluke?] it. Those are the results that we got. [Nigeria 1931-32] Aitken: So what happened after you left Lagos? You returned to the states on leave? Kerr: What was it 34? Aitken: 32, was it? Downs: Well you got married somewhere in here. [Image of Miss Janet MacLennan, 1932, 1954] Kerr: Oh, 32. Before my leave was over we were married. I went to Santa Marta, in Colombia, on the north coast of Columbia, with Johannes Bauer. We set up a field laboratory with the help of the United Fruit Company. Downs: Why did you go to Santa Marta? Kerr: To Santa Marta? Downs: Why did you go to Santa Marta? Kerr: Because of fatal cases of what was diagnosed as yellow fever by pathologists. Bauer was the bacteriologist. He went down equipped to isolate [unintelligible] cause it was still at that age. The virus hadn't yet been identified. He got nowhere with it. [Dr. Johannes H. Bauer, Director, IHD Laboratory, Rockefeller Foundation 1935-1945] Dr. Luis Patino-Camargo enters the picture. He was detailed by the Colombian Minister of Health to assist us in our investigation in Santa Marta. We took additional case histories. [Senora and Dr. Luis Patino-Camargo, Colombia, 1932] Aitken: They were continuing cases after you arrived? Kerr: No, we visited the families of these cases and took histories of the illnesses, and well they had jaundice and fever, but that was not specific. And then this washed out. This wasn't yellow fever. Aitken: Did you ever find out what it was? Kerr: Oh, it was hepatitis, I'm sure. Aitken: Did you stay on in Santa Marta? Kerr: No, they suggested to him that if we were looking at yellow fever, we ought to go to Muzo, where there had been fatal cases of yellow fever. [(1932) Santa Marta, Bogota, Muzo] So, Patino and I took off for Bogota by air on Escanda Airline, which flew five- passenger float planes, up the Magdelena River, stopping at several ports till it got near Bogota and then switched to a land plane and flew from the river up the mountain. But to get to Muzo we, Dr. Patino and I, outfitted for horseback riding, took the train to a town very well known in Colombia by the Indian name Chiquinquira, and it is one of the two places in the Americas where the Virgin Mary made a miraculous appearance. Aitken: The other one being Kerr: In Mexico. In Chiquinquira we hired horses and we rode two days to get from there to Muzo and we took some more tests from children, more or less at random, and there were several positives. [Photograph of man on horse] And we checked for the presence of aegypti and it was much too cool. The altitude was too high. And the town of Muzo was up in the cool country, at the cool altitude, not to say cold, but the famous mines were down near a river which was at much lower altitudes. Aitken: The situation in Muzo was jungle yellow fever, wasn't it then? Kerr: Yes, surely, of course. Aitken: So this was one of the first times that, the expression wasn't coined at that time, but, here were cases of jungle yellow fever. Now this was in '32. Kerr: Yes. Downs: Let me ask you a question. Can you identify this [hands Kerr an object, a "viscerotome"] and possibly tell us what part it had to play in yellow fever? Kerr: I'd be very glad to. This is a viscerotome. [laughter] Was designed to puncture the abdominal wall and go into the liver at which point the blade was retracted and then pushed in further and then the blade was put forward again, so a piece of liver was collected in here. Downs: From a defunct individual. [Viscerotome suggested by Dr. Fred Soper, invented by Dr. E.R. Rickard, 1930 Kerr: Fred Soper conceived the idea that somebody might be able to get a piece of liver tissue in somewhat the same fashion that coffee was routinely sampled for grading. Coffee on the docks ready to be shipped was in very stout burlap bags. An instrument was developed which would go between the strands of burlap and open up and take in a few coffee beans, and this could be repeated on every 10th sack of the shipment and enough beans were Aitken: Extracted Kerr: Collected to make a good sample which could be roasted and then made into coffee, and tasted. And expert coffee tasters were part of the export apparatus of coffee. Well, Rickard took this request of Soper's and he tried to invent something that would do this for a liver specimen, and he spent I don't know how long, but he gave his body and soul, and eventually came out with this instrument. Aitken: Well, Austin, yours has been a fascinating story of yellow fever as you have lived it. But time is running short and I think perhaps we should move on to your experiences in the field of malariology. Kerr: Okay. I am not a malariologist, I'm only a malaria eradicator. After all I was an admirer of Fred Soper, I learned a lot about the eradication operations from him. So, I would like to recount briefly the episode of the eradication of Anopheles gambiae in Brazil. [Anopheles gambiae] This is an African species, present all over Africa, and always associated with lots of malaria. But how did an African species of mosquito get to Brazil? [Map of Africa and South America] Well, it got there with a French ex-naval cutter which took the French airmail from Paris, from Dakar, across the South Atlantic to Natal, Brazil, where it was put on a plane again and taken down the Brazil, to Buenos Aires. This trip, in this cutter, was driven at top speed, regardless of cost, took about 3 days, and an Anopheles mosquito, which was inside the boat could survive and then look for someplace to, if she was a female, lay some eggs. A very suitable place was the banks on the river beside where the cutter docked, in Brazil. This service had been going from some time when there was a severe outbreak of malaria in the city of Natal, Brazil. Aitken: Northeast Brazil. The Brazilians knew malaria, and they knew that the problem was serious. Well, Raymond C. Shannon, of the Foundation staff, was the entomologist on duty at the Yellow Fever Laboratory in Brazil, and he went up to Natal and promptly found Anopheles gambiae there and identified it and that explains why there was a serious epidemic of malaria. [Raymond C. Shannon. Salvador, Bahia, Brazil. 1929 Measures were taken to eradicate gambiae in and around Natal, but 3 or 4 years later, gambiae was found 100 miles northwest of Natal, on the north coast of Brazil, precicely where the southeast trade winds which blew strong across that country would have carried it. It went on further west into the state of Sierra, and up the coastal rivers causing a severe epidemic of malaria. It was a much, much more vicious vector than any of the Brazilian species, and threatening to go on further west. If it had gone and had reached the Amazon Valley, it would not have been eradicated. We would have had it forever. So, Fred Soper was the Foundation representative in Brazil office in Rio, and he had established a very good reputation for successful operations and, to make a long story short, a malaria eradication operation was undertaken, eradication from the start, in northeast Brazil, by the Brazilian government, with some financial help from the Foundation, and much more valuable help and personnel from Brazilian physicians, public health officers, who had long experience in the eradication of Aedes aegypti from large parts of Brazil. So, they knew knew the concept of eradication. So, in short order, gambiae was eradicated from Brazil. I had nothing to do with the field operations, I was stationed in Rio. All I had to do was administrative, supportive work, for the project. But, I was familiar with the technology of eradication, of gambiae as adapted from Aedes aegypti, and had this experience to my credit. Downs: What was the methodology, did Marshall Barber get involved with this as a consultant early? Kerr: Yes, he was given valuable advice on the field. He was most interesting. . . his favorite virucide was Paris Green, of course, and this was the larvicide used in Brazil. [Marshall Barber, 1954] [Paris Green] This technology was eventually transplanted, in toto, to Eygypt. Aitken: When did this become a problem in Eygypt? Kerr: 1942, there was an upsurge in malaria and it was identified by an Egyption entomologist, M.D., named Dr. M. A. Farid. [Rockefeller Foundation Gambiae Eradication Service (Egypt)] In 1944 the Foundation was invited to assist in the eradication operation in Eygyt. I was tapped to head up this work for the Foundation. Aitkin: Who was your field . . . Kerr: Of course . . . Aitkin: Bruce . . . ? Kerr: Bruce Wilson, who had been in charge of the operation in. . . Aitkin: He was the field director . . . Kerr: He was the field director, and I remained in Cairo, the capitol, where the Ministry of Health was, and he was 200 miles up the river at the city of [Asyut?] which was at the northern limit of the area invaded by gambiae, which in Eygyt extended 600 more miles to the south till it got to [the edge?] of Egypt and Sudan, which was the northern extension of gambiae. The Egyptians undertook to provide all of the facilities and pay all of the expenses, except our salaries. We started to work, and there was lots of malaria. The whole infested area was divided up into zones, just as it had been in Brazil. [image of works spraying insecticide: Spreading Paris Green] Aitkin: You were appointed director in July of '44, and when was eradication achieved? Kerr: About a year later, August, I think. Aitkin: In '45, around November, I think, wasn't it? I think I have that . . . Kerr: I don't know, but it was in 1945. Aitkin: Yes. Anyway, you achieved eradication. Kerr: This was an episode of my life of which I am rather proud. Aitkin: It was a great feather in your cap. Downs: You did have further malaria experiences in the Far East and in Salvador as a consultant to AID. Kerr: Yes. I have some pictures which we're not going to show that I took in the Republic of Panama showing a house with thatched roof and very flimsy walls of which there are untold millions in the tropics of the Americas and all over elsewhere in the world. [Photo of thatched roof in Philippines] The people stay outside their house in the cooler evening for the convenience of mosquitos. You can't control the transmission of malaria by spraying the insides of those houses, as experienced in the government. Aitkin: The spraying of DDT. Kerr: Yes. I also have a picture that I took from an airplane flying over Laos, which shows patches of essentially virgin forests and other patches of fields being cultivated, and other patches which look to me as if they were covered with second growth. [Image of land in Laos] In this photograph there are numerous little white dots, each of which is the roof of a house. Scattered houses in an area with no roads represent an impossible, an insuperable impediment to the successful use of DDT as a residual spray on the inside walls of houses for the control, not to mention eradication, of malaria. [Same image of land in Laos] Downs: Well, there is an implication here then that you were not ultimately surprised yourself when malaria eradication as a worldwide achievement began to run into difficulties. Kerr: No. I was never sold on global eradication at all. But there was research to be done, and I felt myself competent to do that and so I, with the blessing of the Foundation, engaged in it. Downs: From my own interests in arboviruses, I would like to make mention of your period of work in the New York laboratories and significant contributions with the use of the complement fixation test, in helping to classify a group of viruses that at that time had not been fully understood in their interrelationships, what later became known as Group A and Group B arboviruses, later still as Alpha viruses and Flaviviruses, etc. And then your assignment to India where you organized and got operating the Virus Research Center (VRC) in Puna in collaboration with the Indian Council of Medical Research, a center to which various Foundation staff members were later assigned, including Harold Johnson, Charles Anderson, Telford Work, Harold Trapido, that may be about the list, and Jorge Boshel, someone with whom you had earlier associations in PAHO and AID. Then your eventual departure from the Indian scene when Telford Work took over the laboratory and later Charles Anderson, with T. Ramachandra Rauas a very valued collaborator, one might mention, in the whole Indian scene. Kerr: Yes. I still correspond with Dr. Rau. Downs: I also . . .a very wonderful person. Aitkin: You retired from the Foundation in . . . Kerr: At age 65, in '65 Aitkin: '65. After about 40 years service. Kerr: And 3 months. [laughter] Aitkin: I think you should be congratulated on a very rich life. Thank you very much, Austin. Kerr: Thank you. I enjoyed it very much. [J. Austin Kerr, M.D. Rockefeller Foundation, Retired, April 1981] [Interviewed by: Thomas H. G. Aitken, Ph.D. Senior Research Assoc. Epidemiology. Yale Arbovirus Research Unit] [and Wilbur G. Downs, M.D. Clinical Professor of Epidemiology, Yale Arbovirus Research Unit] [Produced by Audiovisual Services Laboratory Improvement Program Office] [In cooperation with American Society of Tropical Medicine and Hygiene] [Centers for Disease Control, Atlanta, Georgia]