~

be

MY lew : . fg 1 a8

Soak mole ow se Lif finer

 

Noy 24, 196° J Ay drbug Fal- (461:

Karachi, from gistriot of Colfmbia via Newyork, November 24,1960.
Thanksgiving dinner with Turkey at the home of Ruth Puffer and her mother.
Sam giddleton of Chile and Mrs. Chaves of Bragil with her five children
were also there. Dr. and Mrs. Villavfleal of Mexico, with two of their six
children came in later in the afternoon.

To. .
the National Airport at 16.50 in order to catch EAL }K 864 to Newyork
at 17.20; arrive in NewYork on scheduk and am surprised by the new Eastern

Airport Building but astonished by a circular round house of the Pan

American Airways. Yo. 2 ot
Pan American Atrways Boeing 707, A 20.00 o'clock via London, Franfurt,
A tte
Vienwma, Istambul,- Bewrtet ’and Raracht at 0230 on Nevember 26th.

Novi Bae mw 4ST
arachi, met by Dr. Epil Palm uit and Yr. Pal A. Nicoll, who has been

here for just over five years in connection with the teaching of basic
sciences in preparation for the yedical schoolg#. I suspect /Nicol1) that|he-
is with the Universi ty of Indiana although he did not aef enttit say so.
Mr. James Cassanos, who used to be in East Pakistan, was at Seca Airport.
I am taken to the Sind Club where I find a very pleasant two-room suite
with hot and cold runing water and a very sbescuious 4
himself at 63-30 and asks what time I urged tea. I could not have cared
less but tell him to bring it at 0900 thinking T might be ready to rise
at that hour. ——

Evil Palneyust, whom I tried td here some years ago and who latfer

served time in Iran and possibly elsewhere but had to leave ICA for family

. Ah
earer who annowences

reasons, has been sent out to Pakistan to size up the health situation and
come up with recommendations for a program as an arbiter between the USOM
chief (Killen) and Pease and EPC.

Killen, who has lots of intelligence and common sense,told ICA some
weeks ago that he wanted nothing to do with the health office; that Pakistan
did not need health work, but dams and bridgs and roads and other productive
efforts. EP has been sent out to survey needs and propose some kind of
concert of effort between Kallen 6x the office. Public Health of ICA.

It is possible that JK took the action he did in order to get some
greater interest of OPH/ICA in this country.

P.T.Q.
~2-
Nicoll has a daughter D-#bbie, real name is Ann, and a wife who paints and
draws. Debbie is now a senior or 12tk grade student.

November 26th. Tea at nine, lunch at one,and then to the Nicoll's
with Joe Smadel who arrivdthis afternoon and EB Palmpuist and Mr. Cassanos
te dinner on wild auck» (And 7 ped curned duck for lunch at the Sind Club.)
See a small soft bellia- a “at the home of the Nicolls.

Sunday, November 27th, morning discussion of various matters with
Joe Smadel. (Among other things I ask Joe*‘s about John Doe, learn that/3D
came out to the NIH to crrect a ed tuati en but at the end of a year this

 

situation had not been corrected. (2) Ip was /taken] then down to the surgeon
generals bffice but after a time it was thought best fori: him to go to an
out. of -Washington post to ride hérd some of the PHS interests there. (3) JS
believes that ID may never cause enfmies to be made but that he will not
be powerful in solving difficulties.

Sunday evening,November 27thidiscuss with Joe Smadel the question
of future funds for cholera work and af for the research program. He indicates
taat the bite can be put on the Heart Institute for the salary of dordon
if Gordon be induced to come to Dacca and that in the final analysis meney
can be gotten through the recommendation of the old original committee
on grants of the parent NIH which still functions in the case of new fields

and was recently used by J.S. (that is a year or so ago) in geting funds fore

Journal notes.

November 24 Washington.
qe?
November 28, Karachi

a ”
AA At Ae Awhs

The international field and the constant necessities of USIA and other
US proparanda in being against communism instead of being for something,
there comes an interesting discussion of what our objectives should be. K,.
says that he had an opportunity last year to talk seriously with Averéll
Harriman and tried to impress on him the necessity of changing the US
approach to international aid. As a matter of fact the preamble of the
Mutual Security Act was altered this year and K. suspects that this change
may represent AH's intervention with certain members of Congress. Not to
be outdone in citing the names of important persons I related a story of the
initial development of the IIAA and my part in the early discussions with
Nelson Rockefeller in !41+%42, I pointed out that all too many of our

v

people think that we want to build somethine we can point to with pride as
a USA contribution whereas our single objective should be to ake it possible
for the people of each country to carry on for itself. (K, then gives the
story of what happened here in the solution of the housing problem of the
refugees! When the Government got really interested the USOM financed the
construction of a large number of quarters which have been recently
inaugurated, The USIA and other sections had been anxious to take pictures
and make active propaganda of this work of the US but K, insisted on leaving
all of the credit for the Government. As a result on the day of the final
inauguration the President gave full credit to the USA for its part in the
program.) Towards the end of the evening K. asks that I make myself avail-
able for consultation on problems not: related to cholera and I,of course,

cannot ref:se to do anything in my power. I did not, at this time, call

attention to the complications which may result except to point out that
De
I am mak now under an appointment, until ‘ext July, aS consultant to ICA,
(I learnt from JES that he had assured K. earlier in the day that I might
be very useful to him because of my previous experience in international
health work. K, had told JES, it seems, that he had never had, in the
field of health, representatives of ICA who co:‘ld meet the doctors of
Pakistan on a man to man basis, Kingsland, Donovan, etc., and that it is
hopeless to try to work up useful health programs under these conditions.
It seems that K. recently indicated in definite terms that he expected to
close out all public health work for the USOM here; the result of this
attitude has been the demand from headquarters for a survey which is now
being carried out by Emig Palmquist. So I may soon find myself in the
muddle! Not too happy a prospect.)

One of the interesting things learnt on this visit is that a recent
meeting of the Pakistan Medical Association was set up as an international
meeting with great emphasis being placed on the participation of the USA,

It seems that the Pakistanis had invited the Red Chinese and the Russians

and then felt that they might be misunderstood, if there were no American
representative. Advantage was finally taken of the presence of Ochsner in
this part of the world to have an American present. 0. presented a paper

on lung cancer but the representatives of the Communist countries made much
of the story of what they had done in the control, nay, eradication, of such
diseases as smallpox, malaria, cholera, etc., the diseases which continue

to be serious problems in this country. Obviously the USA was out-manoeuvred
at this meeting.

November 29. Tuesday.

To the ICA with JES to see Mr. Owens and Mr. Siegel. (0. is a bright
-3-
young man who has been through a period at Bureau of the Budget and S, is
the lawyer of USOM.) For the first time we get in contact with the working
element of the US Government who know about the agreements with the GOP and
about the handling of funds. 0O. tells us that the procedure established /4
for a fiscal officer of N.I.H, to make a request to the Treasury department
for the purchase of ?? number of rupees; the Secretary of Treasury
then aske the financial officer here in Pakistan to make ?? rupees avail-
able to NIH. The fiscal officer eventually gets word at the NIH that the
money is available and makes arrangements for authorised persons to draw
on these available funds. (Funds for cholera can be dispersed (1) through
the American Conculate representative or through ICA Finance Officer in
Dacca (2) through the Director and Deputy Director of the Research Laboratory
(3) through a special admuinistrative officer from NIH sent out for the purpose.
(The latter sugsestion I consider unnecessary and state that it should be

-

possible for the Director and Deputy Director to arranre between them for
the consigning of all cheques for the cholera work, U.S. Government cheques
must be signed by an American citizen.)

O, and S. agree that the Minister of Finance must he told about the
use of PL 480 funds for cholera but that agreement with the as
such does not require their concurrence,

The problem of nutrition is not simple and JES does not insist on getting
action on this program at the present time, 0, and S, discuss the possible
handling of nutrition andMaryland funds by ICA,admitting that ICA believes
the activities of other American institutions in their field should he

curtailed, JES explains that the money coming to Pakistan on the University

of Maryland project is not NIN money but university money by the time it gets
~4—

here, (MD chose Pakistan knowing it is a very difficult area; JHU chose

India (Calcutta), Tulane chose Columbia and ? chose 7? )

To summarize:

1. Cholera 480 money use will be reported to the Minister of Finance and
arrangements made for its usaze witho:t any anticipated difficulties,

Qe Nutrition 480 plans are still nebulous and more details will have to
be worked out before apnroval of GOP can be requested;

3. Maryland University program is to begin with US dollar but may want
to use 480-104K money later; even though arrangements are to te made
by Md directly with some university in this country, there should be
overall agreement on the proposal between the US and GOP, (It is
essential to have agreement which will cover treatment of foreign
personrel brought to Pakistan and the importation of suoplies and
equipment.)

Owens and Siegel are to set their heads together after a study of all
available doc-ments and come up with definite proposals (7) (1) some overall
agreement between NIH and ICA? (2) some overall agreement between US and
GOP? (JES insists it may be difficult to have another agreement between
ICA and NIH since the operating agency will be the University of Maryland.)

Macleod, Smadel, Soper and Woodward drive to the BSMI and visit with
Paul A. Nicoll; P.A.N. suggests (1) National Research Council of Pakistan
be used as operating agency for nutrition provram (this should he feasible
since NRCP is in the business of making grants for research projects);

(2) all plans in which rupees are involved should be set up in such a way

that the GOP will provide 10 per cent of rupee value for dollars or other

foreign currency purchase for needed equipment importation!
em -5-
oy

MacLeod, ss 7 \rw and N. lunch together at the Sind Club; Mac. and TW
leave by train for Maldun and Lahore possibly also 'Pindi and JES leaves
by PIA for Delhi,
November 30, Karachi
(1) To ICA = Owens out but talk to George Elmore re Dacca situation;
ICA Chief Chas. W. Edwards (Col. USA ret.); Paul Schuler (Labor) has acted
recently as deputy (RR)} James Cassanos now detailed to ICA/Karachi (is
to go back to Dacca); Richard Towle, sanitarian, 3 years in Dacca (trying
to run a school for sanitarians), and Sam Morch, health educator. Health
work at the present time largely limited to jet gun vaccination following
the hurricane floods of some weeks ago (4 guns in East Pakistan and 4 in
West Pakistan).
(2) Learn that Cassanos talked with Major M. Siddique (Te1.51269), Director
of the Nutrition Survey, and told him that Smadel was coming: but JES got
away yesterday without seeing N.8. I find M.>o. in Paul Nicoll's office
and immediately read him his telephone number and give him his title, all
from a paper in my hand, (N.S. is small, wears what might be called a
caftan in some places and has a white and black beard. Siddique was in
the army and carried out the survey of nutrition in the armed forces here some
time ago and has just been named as the Director of the Nutrition Survey of
Pakistan. S. realises that he does not have the staff nor the organisation
to work with that he had in the armed forces program. Nicoll disc:sses
frankly with S. some of the problems which he must face if he is going to

be able to use the money already in the budget of the GOP as well as the

money of the NIH. I explain to N. that there is a proposal to have an overall

: ‘ h projects
master agreement covering its modus operandi of syecial researc a : ,
-~G—

permitting individual projects to he brought out under Special acreements,
(3) Lt.Col,. S. M. H. Bokhari has been charged with the development of
National Laboratories at 'Pindi; has money to buy land and get started on
plans; B. is one of the official delegates to the @holera Conference next
week in Dacca,

To the home of Dr. and Mrs. Nicoll where I have canja and meet the
14-year old son.

Afternocn of November 30, With P, A. Nicoll return to ICA where he is
responsible for the expedient in the absence of Cassanos. See lr. Owens
in the hall and he asks for appointment later in the day.

To the BMSI with Dr. Nicoll to see installation ofthe Institute and
something of what is being done. I am duly imeressed; the BMSI has six
departments: Physiology, Microbiology, Anatomy (Histology), Biochemistry,
Pharmacology and Pathology; a library, carnentry, machine shop, incirerator,
generator, etc., and animal breedirg rooms all air conditioned (white mice,
rats, rabbits, guinea pics, cats, lizards, ete.)

There are annarently foreign chiefs of each section (Minten in Micro-

biology and Tucker in charge of the repair siops, obviously from Texas.)

 .
‘ks

te Vek F
PLAN, Sys big 21 students in each of the first two classes; the course
’
is a two year course for those who should be teaching in medical schools
soon. Emphasis is to be on research methods and research tra’ring. (The
BSI locks like a very go-d show; P.A.M. believes it is an example of hdéw
ICA should work on every project. BSI is under a contract with the University

of Indiana. »°.A.™. says that for teachirg ICA should go to teaching

institutions and cet there the organisation and exnerience, and for nursing,
-7-
ICA should go to a nursing school in the USA and contract to set a school
organized over here rather than to aid what has deen done here--working hard
trying to run a poor show.
(.A.N, is not always popular with the ICA but I believe they respect
him and his judzement.) The Minister of Health, Burki, was recently brought
to the BMSI and was quite astounded at what he saw, He asked how it was
possible that no one had ever told him of this develonment??

Return to hotel where Mr. Owens calis for me about 1645, We return
to ICA where James Killen speaks up quite frecly: (1) he was not too well
impressed with the idea of having NIU resea:ch projects started in his country;
(2) after talking with JES and learnira of the plans for staffing the Cholera
Laboratoryand the Md. tropical diseases project, he has changed his mind
about these pro ects and believes that these projects may well be the means
of making the ICA health work stronger (3) he asks me to give this messarce
to JES and says he is ready to help these two projects in every way possible
(4) he is ready t- consider takire a good young doctor to run the adminis-
trative part of the health services if he can depend on NIE for technical

(5)

policy advice. ,He asks if I am willing to collaborate as which poi t I
speak up rather frankly about desiring not to hecome a controversial figure
between NIE, JK, and ICA, (6) I give something of the story of the relation-

ship betwecn the USPHS and ICA in the past and indicate why ICA has such

difficulty in getting and keeping the type of leaders we sho'ld have in the

ae

ube

health field overseas. (7) I als give a story of my relationship with the
malaria program during the past year and indicate that -malaria eradication
is my chief interest (8) indicate that I saw little chance to contribute to

malaria eradication under present skxak stresses and was therefore vulnerable
~S-
when JES brodached the cholera project. (9) I go so far as to indicate that
there is no financial incentive for us to come to akistan but that I have
been preaching for years on the necessity of taking communicable diseases
in their permanent foci of infection rather than try to control their
spread through quarantine (10) that we are not playing for peanuts in
Dacea but looking for a break through which may result in freeing the world
of thi:: disease (11) I indicate that I believe good men can “e found to face
up to the challenge of foreign public health service if they are permitted
to work freely on imaginative projects, etc. (12) I point out that I am
basically desirous of being heleful in every way possible and that also “he.
success of the cholera effort will probably denend on the op ortunity to
work with organised health services in East Pakistan. (13) I am therefore
ready to commit myself without committing the NIU. (14) JK indicates that

his service and men are not among those which are run from Washington and

poe SOP PRR A

  

that he wants to work out a deal] to take full advantare of NIH
in this country.

After we leave JK, Mr. Cwens comes with me to the hotel and makes a
more definite statement revarding JK's plans to get out of the box with the

lack of personnel from the OPH/DC. (During the talk indicated that Donovan
hans SD

is an .nice: person but coasting.)
Owens talks some details of plans for the future indicatine that under pressure
of reducing budgets this year JK had decided to concentrate on the BMSI and

* ae EAA. wba. Sy py ay

on the training school for nurses and make these two projects good , letting

other health activities await future possibilities, O. asked me then what

should be the next step.

At this point I took out the time to discuss "health centres"
vs, unilateral programs and pointed out that most of our USA trained

workers in public health have been tsught to avoid the unilateral pro-

eat +
gram. In Pakistan both needed, our in its own place and at the proper

time.
a whe a me a pr
A i ne Pes ow te ee fiw ) O\ Cates i ~ cf , 9 le
b.

December 1
Dr. A. K. S. Ahmed, Professor of Medicine, Dacca
Karachi to Dacca; joined forces with Miss Jane Stafford, whom I have known
since 1937 at the airport, Each of us does a considerable job of sleeping
enroute.
Flight 114 PIA: 0700 to 1320, We are duly met by Drs. Stockard and
John Feeley.
To the home of Consul John King where I am to be during the week here.
Cases of cholera have been found recently just across the river from

nw u ina ~
Dacca and today cases have been found even closer to the city; then half a
ate bis who
mile «a#ts<" to Dr. Feeley. (Dr. Mansur shamwket arrived back from the USA

a few days ago has been out investigating these cases.)

December 3, 1960. Dacca

With Drs, Stockard and MacLeod, called on Brig. Hyder. We find

, Po fte, ;
fea _ fay Lege M, be! RMP, Bay anil Merten

Dr, Helwani, Deputy Direétor, Regional Office of WHO, in)/and an engineer
of WHO there ahead of us. (Also Dr. Ahmed and Dr. Malick were there).

Helwani and I bring the discussion round to the subject of /yellow

twe - mo oe
fever \e radication of Anephe les gambia¥
o a + te ee .

To the P.X. with fees A.S. and“May the manager who says she does not
have a list of items but has only a card index. She says the selection
of articles in the commissary varies greatly from week to week so I decide
to bring out just the things that we like best.

To the kboratary once more, this time with Dr. MacLeod. Suggestion of
some sacks of calcium chloride to lay the dust at the Research Laboratory.

Question of where the plaque referring to the dedication of the laboratory

of the SEATO should be placed; discussed with Hyder and Haque before a
decision is taken.
Dr, M. Rahman: Studies at University of Illinois with thesis on
cholera vibrio (nutrition) now with the Davis Chemical Co.
Dr. Ataur Rahman, University of Michigan now in charge of cholera
vaccine production (KD, MPH),
If hired, how could we get Money to pay decent salary?
December 3. Dacca
In discussions with J. Stockard, it becomes apparent that many of his
problems are those we have had to face in other countries with other
programs,
1. Adequate salaries for national scientists,
2. Transportation for national staff,
3, Administration of cholera hospital - Nurses number? qualifications?
4, Character of cholera effort? Truly resional or partially so?
Bilateral? USA and Pakistan?
” -
5. Suspension of all USOM positions not now filled! Hence now no ICA
representation on Advisory Board! James Cassamos, Richard Towle,
Samuel Morch)"Mr, Towle is a sanitarian who has helped the GOEP
build up its sanitarian sicool and has also travelled widely in
East Pakistan, using the high pressure injector in fighting epidemics
of cholera"!! Towle now interested in program for sanitation of
villages with Bored hole latrine,
“We are eager to provide assistance to the limit of ovr capabilities

when there is a GOEP progran to supplement." The £xwak above is final sentence

in paper prepared for GOEP recently by ICA.

* After present terms present incumbents will not be reappointed.
Memo duly 22, 1960, NIM/ICA responsibilities. Parazranh 2 of Section c
states;

“ICA will provide necessary operational and policy guidance through
USOM/Pakistan. The Chief Public Health Adviser, Dacca, will participate in
the project and, to the maximum extent possible, regular ICA medical and
public health programs will be coordinated with the project."

(Under date of October 21, J.C. indicated to Edwards that senior tech-
nician would serve.)

December 3. Dacca.

Dinner at the home of Mr. King, Consul General of United States.
Sopher with beard (of Arab extraction but admits that the name Sopher is
of Jewish origin meaning teacher (?) SAper, sophir, etc.

R. N. Phillips, with beard, and altered personality! Mr. and Mrs, Blood,
Mr. and Mrs, Senna and many others, Those at the dinner were Consul General,
Bloods, Stockards, Sennas, and MacLeod, and Miss Jane Stafford.

After the party breaks up. Mr. King and I remain to take coffee and to
talk. This brings about a discussion of the type of organisation which we
should have in the PSCRL: K. wants what I do, namely, that this should be
something more than an ICA operation; it remains to convince the US people
on this but the British have already brought up the question and others will
do so later.

December 4, Dacca

To the airport to meet J.=.S. and find the Thailand delegation including
Dr. Bin and others I have known. Also Dr. Black from Australia. (1 learn
from Black that he is interested in having some of his people come here to

work with cholera).

J.=.8., John Porterfield, K. Goodner arrive together. J.E.S. and J.P.
come to live at the Consulate.

I learn King, the C.G., has worked in Equador , Argentina, and Uruguay,
has had a year at the War College and 3 years at the U.N. with the USA
delegation.

In the afternoon to the laboratory where I find Dr. H. E. Shortt and
others re-united to discuss program for the Cholera Conference, Others
present are Porterfield, MacLeod, Goodner, smadee, Phillips, Shortt, Stockard,
Malick (U.N.), Woodward, Mansur, Feeley, Miss Williams, Smallbones.

15 minutes summary of what went on in our session.
pee

J a G f

Dacca ~ December 2, 1960.

J.M Stockard : Question of vehicles for ICA advisers .

is one of difficult problems with GOP.

Govt. Guatemala Bldg.

ot “ of
Each member Government — 317.500. ——

Adm. = PASB,

1 rep. each member country.

I

‘Bir, Couneil
Dir, PASB

Meets on wale a4

Budgets ~

i

Approves programs.
!

Administrative Procedures.
J

= Reserves for pension.

Grading positions.

establish salaries,

7 .
inca?
;
Research Centres ~ pH. H#d.;Ph. Adm.

i Countries —paBB, “JOG > o0c.—

Pas % Y~o, COE.

Kellogg. 40, e000 =~ 5/9695 - #452 cco. &

P.I. U.K. Thailand, Australia, U.S.A. Pakistan, N.Z., France.

GOO, OOOO.) aris
U.K. £10,0095CATO Charter to over , vontract with ICA ~- Contract with
Government of Pakistan. - PL 480 gnone 4

Le!
Pee Pn, I< + jar

(> BALL eth,

Reaet ’
we“. olde,
Meeting December 5th : R.A. Phillips, Macleod, Smadel, Woodward, Goodner,

 

Stockard and Soper.
Six months objective: Bacteriological laboratory; complete lab. for diarrheal

diseaseg;¥ Serology cholera ( Diagnosis ) Vyne

Capacity to store isolates for future Exe’ in USA
( Mansur has fluid for 3 days from lab.)
Monsur should train one man for freeze dry. Freeze dry on first passage.

Type specific antibodies to organisms. ‘who will relate isolate to clinica,
story. Monsur has to save something of everything for K.G. checking.
asc

Let us get collection of e&l vibrios. What is a case? What is cholera ?

Laboratory is basic tool.

 

Cisf Rise and fall of vibrio population over season ( Lucknow : vibrio +
h
bacterioplage = cholerae . K.G. is interested in above.

 

, What do we want ? Dry land area’less than hours travel from
laboratory. Cockbua’ proposed (1) 5 mile radius of Laboratory for all types
of conditions ~ Should be started at one place or two places ? Kukxe 4s
Nutritional studies essential, Make longitudinal study of population where
cholera may occur in future ~ then study when disease occurs.

I| Wahed is out of Govt: put on consultant basis,

Fill hospital; treatment and train in treatment
NAM ey
( Neme-Rue interested in say 3 cases a week to study ).
Cuestion of Hospital; to take or not to take.

December 5th, Dacca, East Pakistan :

 

Dedication of PSCRL ~ red, green and white decorated pavilion for
hundreds of persons. ( I talk expansion and internationalization of PSCRL
with Dr. Black of Australia and Dr. Bull of U.K. ( Dr. Black is apparently

from the malaria surveys of Australia.)

( Koch 1883 vibrio in Egypt )
} anal
IT met Mr. Worth, the Deputy Secretary General of SHATO — make .arrangements
to see him in Bangkok after this conference; to set a better picture of what

SHATC is.
Black speaks for Australia at inauguration. Australia cooperates where

possible in SHATO,
Dr. Pin. of Thailand = § Epidemics in last 20 yearsy ( Bangkok, May 23, 1958 )
mentions as objectives the eradication of Cholera from the world,
Adair ,U.K. High Commissioner, falls attention to $10,000 contri-

bution and that U.K. is member of SEATO and interested in real international

cooperation in the common good. ( My government wishes to contribute

and to participate!)

King U.S.A: 8 countries - France, Japan, U.K., U.S.A., Pakistan, PI, Thailand
and Austrailia.

Porterfield - U.S.P.4.8. Cholera was first problem on which USPHS undertook

research in its early years. JF speaks of Cholera eradication.

 

Dacca,December 5th, Afternoon Session:

 

Dr. Pin opens the afternoon meebtingy with a paper of Dr. A.“.™.
Abdul Wahedd, Department of Health,Social Welfare and Local Government, enti-
tledy Classi cal Clinical Disease. ( The reverberation is such that wnile one
may understand words, the sentence structure of most of the sengtences is lost.)
Some of them are found inefficient: our experience has been just the reverse};
how long, ¥¢f OC Kad, how long ? ut

ste
R.AsPhillips - Cholera can be treated with unspecialized staff ¢keé salines
and bringf mortalityvery low ( 1958 Bangkok 6% ).
Symptoms are minimal in cholera cases — thirst much less than

in dessication in the desert,

December 6, 1960 — DACCA:

asm.

K.Y. Session. "hysiological changes in cholera, Dr. Lee E, Farr, Brookhaven
MES A

National Laboratory, N.Y.iHuclear materiais not/much a tool as a discipline ,

 

must be careful to go to the patient rather than draw conclusions in the

Laboratory.

FP, refers to Dr. Van Slack, used same approach to Brigat's disease

as had been so valuable in diabetés.

a ’
Danger of frégmentation of problem; tese-(etse) study the patient as a wholes

Temptation to break down problem into its component parts. Gives mm example
bon

Foe no . pe

Qrh pe bors noe gy te Tit aa ty

in case of anemia where study of jo

? KA of pee. ole cl bry LOH Oy,

)

F. gives examples related to renal blood flow. Capability of
Ann dn wt

patient may be quite different from the condition of the patient's omtoine,
f- S

oT a
Water balance in Usa” of pody could not be studied before isotopes

were available,

Sodium requires hours to come to equilibrium when balance

is disturbed.
LS Farr contd. Dec. 6, 60 — Dacca,

Amino acid entering cell is metabolized immediately; never in
free acid in cell.

Observation fields.

Motility Transit time .

Facretion - Afferent blood flow.

Absorption - (f) Transit time and Efferent blood flow.
Secondary * Renal function

Circulation competency.

Digestion.

i
RF man \ee decreased because of above factors without loss of function.

ulF draws mechanism of kidney and gastro-intestinal tract on similar basis

with regard to movement of licuids. ( Surprisingly similar.)

i

Proposes that we study G.I. tract as 76 ol fed Wet

é

insists that G.I. picture has been building up sometime before it becomes

apparent.

LEF sucgests that material from CIT comes to liver then to lung

and finally may be found in the expired air.

LEP then gives diacram of various methods of using isotopes toe

discover many different changes which occur. Measurements can be made in

stools, by tube in body, or an automatic respiratory equipment which will

measure expired isotopes.

Must study entire patient.

Cholera and Sodium Pump - C. S. Huber, N bl Fel bod

Concentration relations of electrolytes * in plasma and cholera Mgx excreta.

Dr. R.G. Blackwell ( NAMRU 2),
The dehydration of cholera; therapeutic implication.
Capt. R.A. Phillips ,, NAMRU
(1) Replacement of fluid.
(2) Volume for initial balance,

Volume for continued balance,
Dy.

he

Dec. 6th Continued :

How establish rule for fluid intake ?

 

2.4 Failure of acute cholera to give rise to exudative enteropathy —

#RS. Cordon dre, NIE.

Hpithelial barrier not broken in cholera,

\ Cawmeleere Z 136° -

K. Goodner ~ Vaccine is 67 years old wrTY, ZArer eter tase

pad atv a good field test. (1) Public health workers are apt to “
demand vaccination. (2) Scientific workers did not believe it will work.
Daizo - Ushiba Keio University, Tokyo. No cholera since 1946.

BRXEMKX Statistics indicate vaccination was of value in 1916

Tokyo and 1920 Osaka - but K.G. falls attention to the fact that vacinges
were self selected.
Dr. Azurin, Quarantine cervice of Philippine Republic.

Vae. began 1908 = vaccine made with non-motile organism. Today the PI relies

on Guarantine.

(7 ? +, fa pee
Dr. Bin, Thailand ~ 20 million vaccinations - Believes 1959 curve altered

by vaccine.

7) . . ;
K.G. (First area in which new clinical strains were put in vaccine from
week to week. (2) Used very fresh. )

(1) Use fresh strains. ) Recommendation of K.G.

(2) Use fresh vaceine )

 

Dr, Gallut - France.

Reports on vaccination ~ In Indo-China.
Dr. Hussain.
Dr. Smadel - No one would refuse to use RX

XBK No one would rely implicitly on ¥X¥

Present (1) Vaccine and (2) Procedure.

 

John Feeley - Mouse-protection test for cholera vaccine.

Vary vaccine + constant dosage ( Challenge )

Vary dosage ( Challenge ) - constant vaccine.
MEKAXEER DEP XKX ROKK XANES
A
WHC standard weaker thaf NIH - Probable loss in drying.

Ogawa ~ not good against INABA,
Inaba - good against OGAWA,
Mouse protection test good method but what does it mean in & relation

to human co wears te 2 af es

 

UNive nae Te,
U Shiba — Keiop/X% Tokyo.
S. enteriditis serum studies - 1ixe and killed vaccine -

Ataur Rahman
‘ ey
Dillon ~ cable to Conference — NBK would not have presented to ahd have been

signed by Secretary KK of State at least.

KeGe Says that amount of vaccination does not give enough immune body
substance to immunize, Is cholera a local or a peneral infection ?
Comparison with Polio.

Are there antibodies in convalescent sera ? 1916 positive results - but

then not confirmed - now K.G. says immune bodies are developed.

Must use live organisms in agelutenation test — best with fresh
vibrios from current outbreak —
All confirmed cases show anti~bodiess
Some patients had antibodies on admission with cholera.
Immunity group or type ?
Ogawa antibody not on admission but during convalescence.
K.G. has worked on 20 cases of cholera and 60 cases of non=cholera,.
Only USSR vaccine had Ogawa antibodies among all vaccines sent to Thailand -

USSR killed with formalin then phenolized.

Colin MacLeod - Story of Lion saying grace ~- are there second infections

with cholera ? Does immunity explain periodicity of outbreaks ?
Longitudi@rl studies with diagnosis of all diarrhoeal diseases ©

are necessary.

 

No true background in animals ?

Studies : (1) In endemic area,

ray abo,

a ad. aa, . . . .

(2) with teb to diagnose ail diarrhoea diagnosis (1) bact-
eriological and (2) serological.

(3) Random basis = using TAB for control.

(4) Intervals - multiple doses 3 with «4% 4°." @'vog 4 to 6

weeks before expected epidemic.

(5) Size of Group = Cannot be large ~ choose accessible area.
——————
(6) Some history of past.

(7) Carry forward longtime.
2 .
(3) Yrewacn, bleeding.
Mirzapur —- 42 miles from Dacca
Ou hak rel %
990 bed Hospital - Kale Yaar, xeroetiorint fsecopdary to

beTe/ MAA Cerne oe Aer [Vibeepfanesnbbeattn Mh th
amoebiasis}, rheumatic Fever, ~,over 500 girls in school ¢ mot-cancer tetanus.

Major M. Anwar at Govt. House. (Promises 12 months good weather — all in

November, December and January).

Mr. Abbas - Rep. of Phillips. gives autolift.

Dec. 7th.
KGs Is cholera intestinal or general disease ?

How resolve vaccine problem ? C MeL presents procedural outline.
Hi Shortt backs this outline.

Aggelutination test CK with live J vibrios!

Cr cholera Wards at Mitford Hospital with Tw and (Mal =

My first cholera cases; 10 men, 3 women, ( 65 cases in November-every month
has had cases ESM in past 5 years! )

40% of cases from city itself.

{ Smallpox present — not seen.
K

 

cG Reports at Lucknow Drug Institute,

Shrivastava -— Antigens of V,choierae,

Bhashran - transformation of non-cholera vibrios to cholera viibrios—

 

‘Vargapur @holera Hospital: Wednesday - December 7th, 60, Dacca E.P.
(1) Morning session with KG in the chair : pos always a MAte fier fob,
a . . ; , 7 WS .
Raiseg question of intestine against general discase. ilsc asks how vaccine
problem can be resolved. MacLeod sets the standards.
KG tells of positive agglutination test with living vibrics.
G@

Shortt.backs up Mchs piay.

(2) fo cholera hospital with Tv and CM&cL where we see my first cholera

case, some 1C men and @ women, Learn that there have been 65 cases in the month

ct

of November and that no month for the last 4 cr 5 years has failed te register
Cholera case. 40% cases in this hospital are from the city itself although

. . a a 4 , oe
none are reported since otherwise the meport might be practically closed down.

siso learn there is a good case of smallpox to be scen,

~
3) chain ke ane Wem session from 1315 te 1530}

fe told me to come to the hospital and girls school at the

country village. 990 boys, 500 girls in the m= school with % burden ¢

of about six million rupees.
In Hospital, we learn of Malaris (MT) fairly frequent; Kala-azar

vs cade Se! 2 Cen . wet. .
Cease, may Meee ae leprosy}; Rheumatic fever, secondary to infect; scabies
2

. . ee ;
lesions; gamcer, due in larze part to betel ne chewing; tetanus common; expec—

tant treatment best; xerothaimia with resultant blindness, secondary to amoe-

ote
biasis in which gut does not, proteins and vitamins :

Major M. anwarE State House with Governor.

- oe ~ mM 4 an et .
Return with &.G., Rasyugssen, Gordon, Walcott to bridge where

5
Mr. Abbas ( Phillips ) picks me upjhome 1247,

 

CLOSING REMARKS DECEMBER 8, 19603
Australia -— Black
Importance found in history of cholera; Pakistan, SATO and NIH.
many of us would like to work here in laboratory. Document wili be made
- ; , a ertae. ti
miiestone in planning: questions rather than answerivge- them.

(1) Practical treatment of cholera.

(2) Anthropological problems not fully considered; must be taken into
consideration in handling cholera in tne future,

(3) socio-economic status has been associated with decline in CD in
western Qountries.

(4) epeaks of working together in eradicationcTY cholera as a means
of getting better international understanding and collaboration.

(5) Desires to condinue interest in work.

Gallut.

Frances

Deep appreciation to Reks. oh OF

Ushiba ~ Japan : Approves idea of all countries participating
in effort to eradicate cholerag ali Doctors agree with Japanjmust continue
to study and want to collaborate in the future.
Dr. Agurin I .l.

Good mesting covered wide area: WHC eradication prvusrams ~ malaria
th

and smallpox ( tribute to American workers ) 1955
1960.

( Thanks to Pakistan Government for this conference and hospitality.)
Dr. Bin - Thailand : Mostly platitudes. Thanks to everyone in SEATU; ICA,
NIH, NAMRY, SEATU, Pakistan etc. etc. Mentions trip to Mirzapur and accident

enroute.
Kahn

Dr. KEMH tells me about the problems of quarantine with India this year.
ao of col,

At first no country established limitations but India officially aetten

against Pakistan which forced Pakistan to take action against Indian passen-
gers; the difficulty became one of how to isolate and pay for food for

some many pecple.
Dr. H.E. Shortt ~ UK ~ returned to scene of some years of rewarding work.
t A
Coty we dec erat
Conference ; fra at fo oceent available from all countries in

SEATOyarea; still are to learn in practical application of jnowledge to.

M3 SPAR LEE.
eradication of cholera: they doubt it can be eradicated iff time. Necessi-

‘tier on long-term studies on vaccine even though answer may lie elsew¢here - -
in general sanitatfon a£ and better water supplies ? Who knows ? Most

important and best equipped laboratory on cholera in the East.

Thanks to cholera Advisory Committee.

oo

#

Finally I am glad to report with—~ --that gift of 10,000 pounds for more

equipment for laboratory.

ae bea

whlony. “wid on /
All -tin-tecal arrangements and -seedng. every success to
Dr. Soper, my old friend, who is to bey Director of the Laboratory.

Joseph E. Smadel :_ An amusing experience to find out how many
people are interested in gholera and willing to work in final solution of the
problem; namely eradication.

Dr. M. Siddiqui Hussein.

December 8th ~ Dacca:

(1) To luggage shop on first attempt to shop in Dacca; no purchase
made.
(2) Conference Session on Vibrio cholerae; laboratory identification.

K.G. talks about vibrioses and variability although he insists on

the unchanged nature of the clinical picture of cholera over the many decades

of its known existence.

pawns
KeGe bégif began with the classical strain long ¢FySag~) in the Laboratory
but now has a museum of some 50U strains. Variations are sensed but often

difficult to describe. ;
XBR Prof. J. Gallut of Pasteur Institute, Paris,is difficult to

understand but not too far off base +3. 1-4, words on cholera.
. AE te
(3) Lunch at the. staff house; 2h" gor about the early

association of JES,Farr, Bob Phillip, K.G. and Colin MacLeod at the RI
many years ago. .
ak.
Later in the day, her& the story of the Horsfall and Weir, Goof «cl

in reporting the reproduction of atypical pneumonia in the Mongoose. This

resulted in great expenditure in time, staff and money during the early war

years in getting animals from Jamaica and proving them wrong.

(4) Glosing Session of the Conference; most of the summaries are

well done. M. Siddiqui Hussain speaks for the Government of Pakistan.

HE. Shortt announces the gift of £.10,0U0.00.

I take advantage of the PI ( AZURIN ) mw complaints against present
quarantine regulations to point out that quarantine itself is not the answer
and that the PI and all cholera representative countries should be cooperating
financially and scientifically with the PSCRL ( Pakscrelab ).

(5) To the Government House to htgir-( have } tea with the Governor
M. Azam Khan to whom I present my apologies for not being present at the time
of his visit tomorrow. The Government shows interest and promises of support.
(6) K.G. organize party at the staff house; Shortt, Wahed, Hyder,
Hussain, Huq, Bin, Azurin, Prameru, Blpck and others present; Towle with the
witeh—the music and C. Mack. leads in Alluette. ( Learn of C. hls. ALé¢vdsed
alee | & he pick ne Teen of oe the RF. in hei Th and the
virtual disappearance of the rH.)
(7) Left six shirts, white dress suit and 4 Light white suits in one

of the Stockard suit cases.

December 9th = DACCA TO BANGKOK.

 

(1) Farewell to Mr. N.B. King, American Consulate General in Dacca.

{
1 ee ee ce

- a.
( N.B. King is trained as an economist; hay wEK-UA service in Equator -“Argen-

ting and Uruguay; had 3 years as economic adviser to the USA Mission at the

United Nations; then served with the USA Mission in Iraq at the time of the
Baglad Pact. Also it seems he had one European appointment with the State
Department.) ( N.BeK. makes us his house guest except for tips to boys and

laundry.)

N.eBsK. says that he had to sit by and see all of the early
projects of the Bagdad area become just so many ICA bilateral projects;
he believes there is a place for bilateral projects but also believes we
need multilateral ones; says we should begin now if we want PSCRL to be
multilateral.

(2) After arrival in Bangkok learn from C.Pease that the PSCRL
has an entirely unique position in all USA projects because James Killen,

USOM Chief in Pakistan,refused to have anything to do with it. It is based

on an agreement between the USA and SEATU and then on an agreement with the

Government of Pakistan, Rot the Health Ministry, since provision had to be
made for many privileges for the Laboratory. ( C.P. says that JK. finally
changed his position because he did not want NBK to have anything to do

with any project.) The position of Pakistan SEATG Cholera Research Laboratory
is then already a special one which may make it relatively ) cb make it a

multilateral project.

(3) Clifford Pease reports that CENTG,with Headquarters ddtivd in
Ankara, has #“become dh a very active multilateral organization; CENTU should

Capen

be studied to see What may be useful for us in our relationship with SEATO.

boty

(4) Lv. De. on India Air and for lunch in Calcutta ( Dum Dum Air-
port ) with Jane Stafford, Bob Phillips and Lee Farr. Dum Dum to Bangkok
by Qantas in sthrace with Rasmussen.

R apparently from Medical School in Wisconsin; interyed at Bell

1 **ospital in KCK; then to armed forces and **’ pees “cl? with JES

We bids

for a UNL 3 is now at UCLA ; apparently a temporary duty with Namru 2

 

in Taipeh. ( We discussed, among other things, Polio virus vaccine.)

(5) Chinese dinner at the tone Restaurant; TW, JES, KG, FARR, Pease,

C McL, FLS and ho to maxx bed.

(6) Before ott "to bed " x movement I learn from C.P. that malaria
here is really in att a aol the Ws out ‘never really win “tn for eradica~

fo.
foots

i
tion; that the house spraying is to be faced out this year; that malaria is

on the increase and that difficulties are very real with a £¢dfJ/¢¥id series of
ef changes imminent in the direction of the Ministry of Health.
(6a) EHH report on malaria in Thailand, November 29th made available

to Dr. Chas E. Richards, acting Chief PH Division; Mr. Ed. Smith is malaria man
here now; Dr. S. AverysJones and Miss. Louella Lowry, WHO; Dr. Udaya is the

\

Thai Chief of Malaria.

(A) Malaria has been practically eradicated from the great central
plains of Thailand.

(B) "The foothills" region and the Southern Peninsula still have a
distressing amount of malaria''! ( A. J. reports as high as 40 to 50% of
positive children in hills with 7% in the #1¢¢ rice growing plains but only

2% in plains among those {fi not having slept in the hillg areas. Cases,

Octal.
according..to most often in unsprayed houses, which amount to 10%.

g Sof od j
(c) A. minimus disappeared from the plains areas; in the 6 oe Pheak ~
both A. mimimus and A. balabacensis transmit.

(D) Once a year spraying not enough in hill areas.

(E) Administration problems; financial problems; lack of supervision;

lack of surveillance.
Sena,

(F) Excessive Civil Sueveys requirements for training of malaria
personnel.
(G) Premature cessation of spraying.

 

Under Secretary : Luang Binbakya Bidyabhed.
Director General, Department of Health, Kamdhorn Suvarnakich.
Malaria! Dr. Udoya.

Mr. John J. Conroy, First Sec. Embassy Bangkok ~ Mr. Lewis E. Gluck, Spec.

thy
Assist. for SEATO affairs, Bureau of Zax, Eastern Affairs.

br. Ambhan Dasaneyavaja, Dept. of Pathology, School of Medicine, Chulalongkorn
Hospital, Bangkok, Thailand ~ PA «= KAW = MA.

Dr. Kasorn - Med. Director.

2 e
T. Woodward story of Carr¢é1l typhoid ~ Carrell of yellow fever work w died of

typhoid vaccine.

lith December ~ Bangkok :
(1) River trip with Dr. Clara Nigg. Dr. Ambhan, KG, JiS, Lee Farr, Pease
eer

|
Colin, MacLeod, ged Woodward and Dr. .seeeees (Thai).

$

4
he
(2) _  Clgra Nigg is here working on Yeliodosis, a human disease

which is somewhat similar to glanders. It is a highly fatal disease, 95%, of
after

short duration {f/diagnosis; the disease may attack any organ in the body,

but seems often to be mistaken for tuberculosis. Few of the cases are diag-~

nosed but. there must be many more since contagion in the family or in the

hospital is unknown; it seems that there must be almost universal infection
only
with/a few cases in which there is actual invasion of the body tissues with

the production of disease. CN has been able to develop a CF Test for wicrdec yy
which remains positive for some five months aT tse the acute infection and which
can be given a rapid boost by an injec-/ of organvadat/iddd Lacyer.

CN is here apparently under the Army, or rather the Department
of Defenge, since she works in a Naval Laboratory in San Francisco in connection
with the University of California. CN has been finding difficulty getting
diagnosed cases at the Malaria Hospital where she is working; I introduced
here to Dre Ambhan Dasaneyavaja of the Department of Pathology, School of
Medicine, Chulalonjkorn Hospital, Bangkok, who confirmed, in the laboratory,
the diagnosis of cholera in 1958.

Later at the other Hospital where stands the statue of the King
to which we paid homage, I introduced CN to Dr. Kasarn, the Medical Director

bas

of the Hospital, who said he had not known that CN ts here but would now do

eye
- everything possible to help her¢ the information and cases she wants.)

(3) After the river trip to the Temple €tempte) of the Dawn, a
truly imposing structure.

(4) To the Hospital where Dr. and Miss Pin assisted Drs. JES and KG

place wreath of orchids and present a silver plate telling of the act. Met

Dr. Kasurn agd Dr. Sevati ( Dangsvang.)

(5) Lunch at the Erewhan with Dr. and Mrs. Pin and Dr. Ambhan as
guests of the crowd.

(6) To PAA; ask for room at the Clift Hotel, SF night of 13th and 14th;
and reservation to QC,on the 15th.

(7) To the temple of the Emergldy Raddeh with Farr, Woodward and

KG; then to the “temple of the GEMM Golden Buddha.

(8) TW tells the story of what happened to cgrroll of the Walter

Reed Group who died as a result of infection by a supposedly dead typhoid
(7

 

organism ingested during expdérimental work.

(9) McLeod and Phillips discuss possibility of human experiments with
"af Unalsr i x
ve o—Gheoteras ML is against, RP in favor. ( of course, I am neutral,

I see no definite Obstet mm to techy human tests at this time. RP believes
that only poorly nourished individuals can get the disease.)
(10) Discuss with McL, RF Group: Harrar, Theiler, Morison, Coggeshall,

Nelson, Laeb, Berry Wood, Oliver McCoy
Need for stpfe scientific Packing in US and stiff scientific work

in the field.

Remained Bangkok till 13th.
Tyee fee See “pe Dye ce # Qe) o
“On 12th visit to cholera laboratory, to Director Health, Amba-

ssador, Conroy, Sarasin- lunch with We Worth.

ee weecennne -

Dr. Henry Darner, 1835, Eye St. Washington D.C.

y JeRe Wiggins, 2218, We Yoming Aven, N.W.

ee (8) D.C.

aww eoceunanne

Discussions Population Growth :

(1) Nicfllo/ - Dam Builder in India Last 15 years =

(2) Kittsman, Phillips 66 - Oil Field Developer.
“Sle. op sSeecreces Ky Tf, ia
December 13th : Discussion with x ‘in Tokyo Airport; with K later on plane.
“semen eeee mt
N came to India with bleeding ES) | It bleeds no more! Increased
food from irrigated lands brot under datches cannot keep up with population
growth. Recent male castrations are only for money payment, not from desire

to limit population. Priests say we cannot take from the coolie his only

pleasure. N. is discouraged as to possibility of getting population upto

point of wanting something better.

K has not been in India for 15 years but during war was all

over the lot - Burma, China, India ~- like N has a sense of frustration, does
[bes - err

not believe with education ~- catch up with situation. I preach doctrine of

hope ~ Japan, Ireland, France, Italy and USA, and insist on possible rapidity

of action once results begin to appear.

December 12th, 1960 : Bangkok - To the Cholera Laboratory of Oscar Felsenfeld

where we also see Clara Nigg.
Pr 3 Re

O.F. speaks in such a low voice that I get very little of his

opinion
MEXZEM; the recent outbreak he studied was of some 400 caseswith over 100

cases in hispital; no 5« rh Fey
We call on Dr. Kampdom Suvamarich, the General Director of Health.
To the Royal Hotel where we are guests of Mr. Wm. Worth of SEATO.
Afternoon schedule called for,er- modified by the sudden flurry
5 hot
in pT bondh in this part of the world requiring a meeting of the
representatives of SEATU countries. Late in the afternoon we call on

a : a
Ambassador Alexio Johnson; AAJ says I am to be under Fy wbes s7in Karachi

for administration purposes but that for SEATO matters I should work through
bo yey ofp p os
AAJ. AAJ sente--post to individual emuner tas country action by FLS, card

Fe ne ae mn ee ee oe em

preys bt Ying’ groups just so he needs what is going on.

December 12, 1960. Dinner at Palm Restaurant 45 Bt.

December 13th - Call on Pote Saragin, he believes we should be ready to make
Porre plomeke, does nck we can go fast?in development of multilateral
organization.

—Peore-serasin.

Lv. Bangkok 13th Ar. SF 13th - Ar. DG. 15th =

DECEMBER 19th ~ Washington D.C.

To_NIH : (1) D. Parkinson takes over travel account details with air flight
stubs.

(2) Arrange to see JES at 10 asm. on the 22nd ( Thursday ) to fix up
PL 480 document.

(3) Borrow soundy ¢scriber from NIH.

(4) Talk with Don Simpson regarding certain political mmx consider-
ations ( Naeem is meeting with the President of Peru this month at
the home of Dr. Malaga who is a brother-in-law of Pradi ).

(5) Lunch with Oswald§ da Silva at the Cosmos Club; See
problem comes up with discussion; I refuse to get involved insisting that it
would not be fair for one in my position to act in any way» I do, however,
express the opinion that if S is to be an entry in the race for Director
in 1962 that he should resign at a proper time.

(6) Medical examination with C.H.R. Holley:BP 130/74 wt. 201 lbs.

(7) To NIH - Gene Campbell reports on trip to Mexico and the Int.
_
aC

Bey

Am. Fed. of PH As. C says that M.E.Bustgmante do not participate in discussions;
that there was no action of the Mexico Government regarding the present
Federation; that no evidence of any vitality of the 1952 movement appeared.
On the other hand, there were informal discussions with representatives of
several countries including Mexico; one interestijg proposal was for AIDIS to
take the lead in forming the more general organization. ( Oe, Matteson did
not go to Mexico but made EFC his representative. )

(8) Talk to Bredy and Keeny regarding publication of kt ar

Foot

oresent written comments of FJBs letter and on Pawl BeaWer's editorial

suggestions, I find it difficult to have report rewritten as an ICA peng

propaganda document; FJB says Mel Griffiths says our statement regarding
Thailand is net true.

(9) Check Thailand statement with Roy Fritz who agrees it is a

proper if reserved appraisal.

W EL
(10) Discuss with H. Hinman the Publication of Pawl Report and MG's

responsibility tothe Thailand paragraph; HH says he thinks MG's attitude may
have changed after talking with HH this morning. ( When I comment on MG's
becoming original adviser on malaria in South-East Asia, HH indicates this is
not important, since (1) ICA does not have to do what MG advises and (2) the
main malaria man Likewise does not have to pay any attention to him! )

45 minutes from ICA to Cosmos Club by Bus.

(11) Call Dr. Arthur Hollister regarding APHA force.
DECEMBER 20TH :

(1) Call Howard Kline ( WO Ex 35381 or 22833 ) regarding WHO
Fellowship Committee which is to meet February 10th! Since I kx shall be in

Pakistan I write to BJ Mattison to appoint another representative of APHA.

(2) Call Jack ff weir ( person to person FLS expense ) (a)

a 4

e. oe
Decidedly negative respong to suggestion that Ge. ““*iewee, might become

; a
Director of Sanitary Bureau. (b) Name of KX Ernani Brega mentioned but I

( AE beee
pointed out that EB is Brazilian as is also MG Candan. ( In kirter note I
him

be! 7 ee
mention names of Nevin Scriméshaw and Arnéldo Ggbaldon. (c) Jmw assures mw that
DR knows about his opinion of the present Director of Pan American Sanitary
Bureau; now working on Cholera, (d) Assure JMW muxx he should call DR's atten-

BopE
tion to ability of K. bewy.

[&@
(3) Write following letter to Dean Rusk; Dear Mr. Rusk : The good news
Whe

of your acceptance of the invitation to return to the SD praetiae( Ain

Bangkok some days ago.
“t

It is a pleasure to add ny trike 1° congratulations to the ml-

titude you have received. Sincerely yours, FLS.

(a)

(4)., Call K. Bode's office; find him out : I want to discuss/Publication
anes

of Pawi report (b) his success in selling the idea of doing a survey of the
of
salt supplies of all of Africa fouth ke the Sahara.

DECEMBER 21st :

Call on Dr. K. Bode : (1) Get KB to change his attitude of compliance

anek,
regarding publication of Bewl report.

He agrees to take up my position. (2) KB says he has made recommen-
Qiae on
dation wkteh African Survey/salt supplies to the continent south of the

Sahara. . /
BA . Aux
(3) Says that J. Wier of the RF told pe that FLS is the best

person to undertake program in Africa.

Lunch at CC with LLW and Sam Keeny. SK calls attention to
the need of K keeping SK Jr. and the man S ? 7? advised of the position of
malaria eradication in the world. ( Mr. and Mrs. Milton Siegel lunch with
Hu Hyde and Mrs. )

(SK tells story of new statesman report regarding UNRRA representative
in Sicily who was ga said to have asked for a double room when making reserva-
tions for manera and an Italian interpreter! NS discovered too late that the

girl was indulgéng in a literary effort and paid damages for liability to the

UNRRA representative.)

With SK try to call on Mel Griffith but find that he left town this
wrth Lo
morning. (SK agrees fully that my analysis of the situation with the Theoecsl,

that nothing but good can come from the publicity we are proposing of the

Thailand failure.

December 2XX 23rd: Began day at JES office at NIH.
BUXIXBRXBSXXKXXESABAXKLIXEX

(1) Stockard reports Sayeed Ahmed assistant Director of the

Institute of Health,is delaying operations through inefficiengs difficulty is

because this man has control of cholera Research Funds.
ja fe

p i

(2) Stockard has told Monsur he may not act independently of the

Deputy Director.

aw
(3) Monsur continues his suit against the Governmenty yo return to his

position as professor, in which case he would return to his f&trer-€ former -+}—

position.
(4) Monsur not yet officially appointed to the Cholera Research Laboratory.
(5) Will SEATO finance publicity of proceedings cholera conference if

published in Dacca 2?
ivis Garth

Re FLS position Ve-aev.ICA:

(1) Agreement covering this matter is between Government of Pakistan
and ICA. Visi Ting Seavey ee?
(2) NIHappoints VS's only one year at a time.
, a
(3) Agreement terminates as Z June 30, 1963.
(4) FLS appointment is as VS in Geographic Pathology Section NHI.

SEATO Cholera Research Program (1) Research.
(2) Training.
(3) Maintain study bases in Laboratory & Field.

Is Cholera endemic always in Thailand 7?

,Base in Dacca!® Clinical § Acute diarrhoeal diseases
Laboratory @ of East Pakistan.
i

Field Studies §
Training center : meeting of disease + experts.

$400000.00 fund used as reserve rather than routine operation fund!
Propose following:(a) Thailand SEATO CRIL.

(b) SEATO Research Laboratory.
(a) Epidemiology
(b) ° Bacteriology
(ce) Physiology & Biochemistry.
Equipment Epidemiology ?
Once ahe laboratory is operating satisfactorily, activities under
the C R Project will be expanded to evaluate methods for control of cholera.

Cholera in Nepal ( Kathmandu ) :

 

Under date of July 6th, 1960, A.H. Abou Gareeb WHO wrote R. Pollitzer :

(1) Isolated true V. cholerae from case from suburbs of Kathmandu.

( Ogawa subtype )
/
as vf wf

_X4MAS

ho reg.

Under date of July 29th : (2) Isolated 5 ag. V.cholerae strains ( 3 Ogawa
and 2 rough ) some of these cases have been reported to the Singapore
office and should appear in the WHO records. y
Abou Gareeb paper on cholera in Calc utta to Journal, Tropical Medicine and
Hygiene, May 1960/4 " Cholera in Calcutta during the Season of Frevalence, 1959.
Tables from Nedpal 1959-60 suggest : Annual peak period, July-August
Low period ,November to January

Under date of August,3rd : (3) Additional details indicating that

h
cholera came to many parts of KMM# Nepal in 1958 and “59 and that EX isolation

camps were set up in a number of places.

To Do. Prepare quarterly reports for State/ICA and SATU ( 1 Porn mutually

agreeable to ICA & NIH.)

NIH agrees to be guided by policy, instructions of EKAXK State/IcA

regarding coordination NIH work with US objectives in SHATU -

Includes coordination of contacts with Government institutions
in member countries.

Chief Public Health Advisor «- ICA DACCA ?

December 25th, 1960 :; As has been the custom in recent years, Juliet and

 

I spent Xppas Eve at the home of Uswald-da Silva. ( The Brazilian custom is to

wait for midnight to open presents, there being a supper served just after

a tone bs
midgnight. Those present this year were the Beceos and the Solon Camarges and

the Silvas, and the Sopers.

S Camargo tells of the yellow fever outbreak of 1929 on the Ilha of
=

Paqueta and some years later riding the same barcas to and/from Paqueta with

Dr. Soper at 0545 and 1650 daily. ( This was summer of 1933 )
A A,
0. d*Silva*s reministexee about an experience he would never forget
‘

 

a the
with me. He was called to come to Iquaty from Quixgda and was met at the .
heparan t
station in the evening by FLS and DBW; he did not know what he had done wit

was wrong but expected to be fired for something. To his surprise he was

Pairs nth ws td ee i re ba
given no inkling of why he had wot-cabied and weet Ley ta. wl pat iyetee bad

the wiser. At 0100 one of the Brazilian doctors came to his room demanding to

know what had happened; he could only say that nothing had happened. The next
uw?

day he had gone with FLS and DSW to Ico for lunch, then had driven to some place

clear outside of the A. gambiae area to spend the night. Only on return to ICU

font

i]
ahd Liber
the next day was OS given instructions to take over the ICU and Jafwaribe

posts and get them cleaned up. ( He was given full responsibility for
results and was also given full authority to act.)

I got out my journals from 1939 and learnt that this all happened
on July 25, 26 and 27, 1939 : the decision was taken after looking into matters
to let Dr. MAB return to the USA and to remove Dgmasceno Costa and Luis Lessa
as iricapable of following instructions, replacing them by da Silva. My notes
show some of the reasons for the days being full of other discussions leaving
little time to tell OS what was in store for him.

DECEMBER 28TH - WASHINGTON D.C. :

Phe pee AE

¢¥ ‘

Leere- at the State Department that Mr. Lewis Gluck Jr. and Mr. Howard

erie.
“yous of the SEATO desk.

I have an opportunity to tell my ideas regarding the Cholera Research
Laboratory; my hope that it can become a truly multilateral effort; I gave
examples of INCAP and the Finlay Institute in Cr pteeg ,

Le takes over and says (1) That there can be no doubt but that more
funds can be found for Cholera Research Laboratory from USA budgets during
the next five years. (2) That I should be there at least two years
(3) That most important thing now is to get some good work started

(4) That in accordance with Article 3 of the Manila Treaty PH is a legiti-

mate field for SEATU. (5) That so-called donor countries did not want to be

tilde) to SEATO projects on a definite annual budget basis but want to maintain
a voluntary attitude towards our project. (6) Interprets my use of the term
real SEATU project to mean (a)Q@MMX Multi-lateral or even bi-lateral with
SEATO label (7) Discusssthe Indian Problem and indicates that arrangements

rn dn
had been made for India to participate but that the Stave apparently came

on the basis of the meeting in Dacca being called a SEATU Conference.
( LG takes the stand that SEATU cannot be ashamed of its existence and

should never apologise for its activities nor attempt to disguise them. )

A ae

(8) Indicates that SEATU is a convenient whipping by. or scape goat for certain
with
4 woe ae
countried for political purposes but ¢Kd¢ thie séme countries have come to

rely on the existence of SEATO for their own protection; in other words the
BEATO position is stronger than it might appear to be. (9) LG points out that

roy
cholera today, that hes the existing seedbeds of cholera,are a Pak/Ind. mono-~

poly; the solution of this problem is so important to each of them that QD
pry

hou ets 1. { “ee
eventually some medest opergndi will have to ge worked out just as there

has been an agreement finally on the distribution of the waters of the

at.
Indus river. (10) That US has already discussed getting collaboration of other
countrieds on the Gholera Research Laboratory and that the donor countries
want to hold for (11) At this point I take over and indicate that anything,
but especially health programs, have to be sold; and that State Department can

only sell through adizgpk diplomatic channels but that FLS should be able to

talk to technical people in our country since it is thro-ugh the technical

fey a at insane i
prets ar be to.pay. Aypns€ 77 wh,

people that
LG withdraws and leaves me with HJ for an hour. I point out that
(1) Gholera control should be eradication and that it is not an individual

country project but by its very nature must be or inal',(2) That Japan and

the PI sent representatives to the Dacea oe epee + Bh Enough Japan has had no

since 1GaG ! [Also po go 4 Ste ‘ "a

cholera since 1946 and the PE, spent his time in discussing Po erctory

WHO Sanitary Regulations refering to cholera. Even Egypt lost 20900 Lives to

cholera as recently as 1947 and should be interested in cholera eradication.

(3) I reject the idea that the Cholera Research Laboratory should

be financed by so called donor countries; it is of importance to all of the
countries and is the type of thing which all should pay for.

(4) I pointéd out that the Cholera Research Laboratory is the type of
project which should not be put ty ee of Pakistan control because
(a) iss work is of value to all countries and it must be kept accessible to
all and (b) by no stretch of the imagination will Covernment of Pakistan be
ready to take over at the end of the 3-year period terminating June 30th, 1963.
(5) A basic situation of bilateral agreement must be changed if full
collaboration of other countries is to be had : taxation without representation
is tyranny.

(6) PH is legitimate field for SEATU but Cholera problem is something
which needs international collaboration; no country can do this job alone;

I indicate that in the nature of things this project should have been a WHU
project but because of political considerations it could not (have) baen) a WHO
project at this time. . |

(7) I also point out shat So vermene of Pakistan is not able to pay

adequate salaries and establish good working conditions for personnel of The

al
fe éf- 4

Nee. 29> rye

Cholera Research Laboratory; experience already shows that if good people
are to be attracted and kept on the local staff, it is necessary to provide
them with something better then the Government can give. This means that
arrangementg with the Government of Pakistan should be changed so that all
operation of the laboratory is under Cholera Research Laboratory control,
with, Government of Pakistan contributing as do other countries on a cash
basis; just as is done in INCAP. future
LG returns and we agree on a/Xew meeting with JES and the three

of us to explore further the situation.

Call at the ICA and ask HS to send malaria documents to KBade.

upstairs. ‘
P BELL é

43

Pe ‘ th rs A opel on naa

eae (Carged it ach Asbat Beaver will not be in
until the i5th of January. Spent whole afternoon with JES and DP on
agreement between NIH and Cholera Research Laboratory whereby some” 411900

of PL-480 funds can be used by Cholera Research Laboratory.
Discussions with Mrs. Dp today over my relationship to NIH and

ICA finally come to a head today; I point out I have an appointment from the

¥
NIH for 19000 + 17%; that this appointment cannot be changed on the basis of
RBRXEXZXBNRX CONVersations between offices; that any change in appointment

should be proposed in writing by the NIH together with reasons for making

it. I indicate that since November 15th I have been trying to get a docu .
ment on which to make preparations to go to Dacca but have been unable to

get the statement of what I am entitled to.

I also point out that I am not applying to ICA for a position

nor am I taking on job at ICA; that NIH is not a participating agency in

an ICA Program but that ICA is a participating agency in a SEATO Project!
that

I also suggest that if ICA cannot pay 17% but must pay 25% With

calculations $f be made on the 25% basis but that part of payment be

~
withheld under Karat which limits amount which can be received by
. VV

any individual.

ard
DECEMBER 29TH : .
OQ. / ees +
KB fealls regarding population item of of nok Report.

fo:
I agree to his Fer ral ,

U

KB says that the question of Liberia and its malaria service
has come up for discussion again and that AC Curtis is still unwilling to
step out of the picture as suggested by the Embassy and USOM 18 months

ago ett that it is obvious that nothing has been done to impQyve the

basic situation there in the interval.

'Mail"comments on malaria Docs. 272/278- Malaria Inform 65,all
relating to Malaria in Africa, to Weir, Bode and Campbell.

Talk with Gene Campbell (1) advise I am ready to accept KB's
editing of population paragraph,(2) mention 3 papers of WHO on Malaria

in Africa and emphasize their importance, (3) Suggest he call my remarks

a
Get 11500 mile check pg¥'on MB car at 1000 in order to prepare

!

to attention of AC Curtis and of Roy Fritz and Den Johnson.
a]

for shipping at an early date.

DECEMBER 30TH : FRIDAY a :

Ask H Hinderer for pate with someone to advise on purchase and
shipping to overseas stations.
V. Lameroux calls and says he is sending out all of the documents

VL
regarding my case,including a 1956 post report on Dacca! ( &¥ seems surprised

 

when I tell him I have had some months now the April 1960 Post Report on

Dacca.)
VL Jf says qT

Pakistan Afghanistan desk at State, 182-2154.

, Should see Leon B Poullade at state on the

”

Talk with Pease who H says that all is well but that mighz my
reaction is awaited to the proposal of ICA regarding my salary.

Pease says that the situation of NIH is the same in relation
to the SEATO Cholera Project as is the position of Indiana University with
regard to the Institute of Basic Medical Sciences in Karachi. I protest this
interpretation and insist that I am working for NIH to build a SEATU Project
for which SEATO had been given $400000 by the USA. |

Letter is finally written by HH to JES regarding my appointment

declaring that ICA cannot approve my appointment at $19000,

23