VG?
Juae 27 Dacca Tuesday. Morning starts at the office
with an attempt to clear up many old notes whibh have been
neglected all too long. "

An interruption comes about eleven o'clock with
the visit of Mr. William Blackie, the local representative
of FAO; a man who spent many years of his life in Hong
Kong in government there. WB comes in to discuss the ways
and means of bringing about the participation of his nat-
ive New Zealand in the CRL...B says that in general NZ
has insisted in bearing its part in the international pro-
grams ( he recently learned almost by accident that his
country had recently contributed two sugar miéals to Pak-
istan through the Cglombo plan.). «++NZ has been*partic-
ularly active in the fields of agriculture, education and
medicine..it seems unusual that NZ is not parti cipating
in the cholera project which is of basic interest to so
many of the commonwealth countries. JLS points out that

the idea of a SEATO cholera program was mooted at the

_ SEATO Conference of 1958 at Wellington NZ. There Thailand
newly infected with cholera after a decade &f freedom was
responsible for bringing the matter to the attention of
the confereme. As a result of this action the USA and SEATO
signed the agreement of May 2991959 by which the Usa set up
a sum of four hundred thousand dollars to be spent through

the NIH on this problen. I give WB the story of the de-

velopment of the program up to the present time and also
give hig the details of the dealings with the GOEP during
the past months in getting the decks cleared for further
action. I am frank with WB regarding the attitutle of the
USA in its pecent communications to the INCAP type of
organization and take out time to give him the story of
INCAP.... In telling him about the present proposal before
the MINISTER I point out that the only country other than
the USA and the GOP considered is the UR which has already
taken action through¥ the contribution of the ten thousand
L to associate itself with the CRL. ...Under the present
agreement the third country should negotiate with the GOP
in agreement with the United States for terms of partici-
pation..My suggestion has been that the USA and the GOP

should join in iviting the UK to participate. In the case
of NZ it would seem appropriase appropriate for the NZ
authorities to make official inquiry as to the tpossibility
and terms of participation. WB proposes to ventilate the

matter informally with his government.
July 1. 1961. Dacca. Saturday. With JLS to talk with
Big. Hyder for the first time since my recent trip to Karachi.
I repept that 1) Brig. Sherif has seen the draft revision given
to the Minister under date of May 1035) word has been received

from Washington of some reservations regarding my proposal;

3) a document has been prepared for the ministry of finance
pwoposing that the CRL function through Trust Funds during the
interim until the revision is completed; 4) that the CRL is in-

terested in getting direct collaboration with the Health Services
in epidemiological,studies to determine where and when cholera

is occurring organized intthe immediate future (Hyder indicates
that Telakudar ? will be his contact man for this purpose)$3

5) that plans have been made for Dr. Gordon wo come out in Sept.
to undertake physiological chemistry and clinical studies;

6) that there is no need yet for the appointment 6f the bio-
chemist since the material for the chemical laboratory has not

arrived;,) that the equipment for the water lbboratory is being
tratsferred this weell end to the CRL laboratory building; a)that

I am interested in seeing something of East Pakistan and of the
conditions under which ehoéeza occurs (Hyder says there is
nothing better than going down to see the most recent suspect
area on an island off the bb coast of NOAKHALI; I agree to be
ready to leave on Tuesday or Wednesday and be gone for four or

five days$ nq so we close the most frieddly meeting with H

for some time fast.

Last evening at the home of the Bloods I met the Chief
Controller of the GOEP: Mr. Jafari ?

JLS amd I call on Muazzam Hussain who is very much inter-
ested in everything connected with the development of the CRL.
M rather approvves the move to operate ynder the Trust Fund
during the inferim period and predicts that this period will
be a year. I assure him I believe it can be musch less than
that if I have an opportunity to follow it through the various
Government departments to Which it may be referred; that I am
not ready to begin pushing it until I have the full Concurrence
of Washington to all details of my pweweposaél MH asks for and I

agree to give tim copies of my revision draft and of the
proposal for the use of trust funds.
July 2, Sunday.
At home all day.

July 3.

Mra. Haynes, Dr. W. Griffiths, Dr. Dimarchi and Dr. Paltinieri
visited the Cholera Research Laboratory and all came to dinner. Mrs. Haynes
and Dr. Griffiths are here from the University of California, Berkeley,
working on the Family Planning Programme, under the auspices of the
Planned Parenthood Organisation with which Balfour and Jack Gordon were
working in India. This organisation is a child of John D.R. III which
has been helped also by the Ford Foundation! Family Planning was not
heard of in Pakistan under the previous government when the Mullahs had
control but under the present government the Mullahs have been told to keep
out of trouble by not opposing the campaign being set up by government.

Dr. Shimmel has moved to Dacca to be the local representative of the
effort here; the work will be done under the supervision of a committee which
has sanctioned an administrative officer at Rs-500.00 a month. This already
seems inadequate to Mrs. Haynes and Dr. W. Griffithe. The budget for the office
is, I believe, Rs.50,000.00 with a possibility of its getting upto Rs1,00,000.00.

Dimarchi is making his first visit here since coming to Pakistan as
Area Representative of the WHOQ< Dimarchi was here during the war as a P.0.W.
taken prisoner very early in the war in the North African Campaign; he was back
here some years ago working with WHO on the problem of tuberculosis. Dimarchi
understands all of the difficulties of working with the Government restrictions
on staffing and on spending; agrees that no one can understand the situation
here unless he has experienced it.

Dimarchi learns that the Government of East Pakistan has permitted the
budget for the microbiological laboratory in which the WHO was to have
participated to lapse} this leaves the WHO with some $.30,000.00 of equipment,
with Dr. Woolfe of the Netherlands and Dr. Yen of China contracted to come
in the next few months with no provision being made for their reception here.

It seems that Brig. Hyder, who is not himself a research man, has decided
that having already spent money to fix up the Cholera Research Laboratory, it
would be duplication to have another microbiological laboratory supported by
the Province. Brig. Hyder apparently does not understand that a highly
specialised laboratory like the Cholera Research Laboratory is not prepared
to take over the functions of a general microbiological laboratory and that both
are needed here. While the Cholera Research Laboratory can, and should be wil-
ling to, help, it ismt to be considered as a Teaching Institute nor as a
general laboratory for routine work.

July 4th.

J. Cassanos arrives says he came from Karachi to Calcutta with J. Killen;
that J. Killen apparently talked with Jes. but had no comment to make! ( So
that gambit failed) ( J. Killen is to leave Pakistan in August; where he will
go no one knows?)

July 5th.

C.M. not present in the mornings is taking the day off for discussions
on nutrition with Kamaluddin and the Vice-Chancellor of Dacca University.
Water Laboratory materials from Parsons Co. were delivered on the
30th of June and on the 3rd of July. The problem now is to get it unpacked

amd installed.

July 5...Dacca.... Enroute to the office JLS advises me that
Cm is not coming to the office this morning but is goin with
Kamaluddin Ahmed to see the Vice-Chancellor of the University
of Dacca (really the Chnacellor since,u gs gh aki stam usage
the Governor is the Chancellor (oA"2.PP 8 m caught him at
the stafffhouse before leaving for the University; Cm pointed
out that the visit was with regard to the.Nutrition Program
being sponsored by the NIH and had nothing to do with the
delivery of the #$24 000 NIH grant for the study of anti-
biotics and medicinals which the University is getting for

work to be done by KA.) expressed surprise that Cm had agreed

to go with KA to discuss this program with the Vice Chancel-
lor and indicated that I thought that KA should not be allow-
ed to free - wheel with NIH interests at the Provincial lefel.
seecesecseln the afternoon Cm reposted hh that he had had a
talk with J Cassanos with ragaz@ to the developments in Kar-
achi in the negotiation of the Nutrition Agreement; that
apparently Ted Owens has been busy with other matters and
has not acted in this matter (over looking, entirely that —
this is not an ICA project; that nothing abgh T2~actually
happening and that everything is at the moifeit--an dead center.
eeeeCm reports that JC is returning to Karaehi in a few days,
that Brigadier Sherif will be back in Karachi Monday, and that
he Cm proposes to go to Karachi to see what can be done. When
I insist on knowing specifically what he expects to dot in
Karachi, Cm says that he expects to talk with the disbursing
officer about the possibility of making payments directly to

‘Dacca University for their part of the program instead of

routeing all of the money through the National Government
(that is the disbursing officer of the Embassy, which will
be the channel through which funds will emerge)...that he

- expe€ts to discuss the situation with Sherif and inquite

as. to the acceptability of certain changes in wording in the

agreement... and that he expects to talk with others who

may have experience in writing agreements with the Government
of Pakistan......-After all this, Cm will write in to the NIH

making recommended changes in the agreement now being drafted
in Washington, so as to avoid some of the pitfalls Cm has

begun to recognize here.
es 8 I indicate that I see no reason

for'going to Karachi at this time; that he must be careful
not to become the cats paw in a struggle between the nation-
al and the provincial authorities; that he has no basis for
suggesting alterations with CSherif unless he has written
approval of these alterations from 4rnod Schaeffer; that
Sherif is not able to agree to any alterations without con-
sulting the Economic Board which I understand has finally
after consulting with Ted Owens given its approvgéale.ssceee
(CM has forgotten that the Vice-Chancellor is the one who
should take up the mateer of direct receipt of funds with
the National authorities and not an administrative officdr
Daccq...July 5 page 2

of the NIH. Cm also seems to forget
that in the hierarchy of the Orient he is not in a position
to negotiate as person to person with the Vice-Chancellor
and with the Director af Health Services, even though he may
have a letter fromArnold Schaeffer asking and authorizing
him to look after details here for the Nuttition Program.
I suggest that Cm should act by reporting to the NIH and
should make no move here until instructed specifically to
do soO«seeeel further suggest that he might find it useful
to siggest to Dr. Schaeffer that he see Joe Smadel, read _
the CRL agreemant and my voluminous correspondence on it

t
since March 14th, in Smadel's files.), indicate to Cm that

if it takes my authorization for him to move to Karachi at
this time that he will not go.....

In the evening, JC comes
to dinner with the Stockards and the three of us have an
opportunity to discuss ‘the Nutrition Program and Cm8s re-
lationship to it. JC says that Cm had talked with him in
the afternoan and that he had indicated to him what the
present state of affairs is in Karachi, that Ted Owens has
been busy with pressing matters for Killen and had not been
abbe to give Pavcek immediately his analysis of the Nutrition
Agreement but had not suggested that there was anything to
be gained by going to Karachi at this time. JC was surprised
that Cm had been to see the Vice-Chaocellor; and said that
he was sure that no one in Ica would want to see him talk-
ing things over informally with Brigadier Sherif.

In the above account I failed to list among the things
Cm proposed to do in Karachi was to talk thing s over with
Mahor Siddique, the national authority who signed the agree-
ment with Schaeffer, and the head of the entire program.
“ reaspn for going to talk things over with Siddique is that
S has no one in East Pakistan representing him, in spite of
the fact that as things are now bg@ing planned most of the
work on this program gbghgiag during the firat two years
will be in the east wing... I suggest that there are postal
services... and that in any case it is not the function o
a representative of the NIE to act as messenger boy £oe

Siddique y fo Ke Chins.

 
July 6...certain correspondence from Washington regarding
other matters and an indication that correspondence is taking
six days to reach the DC but so indication that my letgers
since the secind of June have been eceived....

Talk with Dr. Dimarchi regarding boats about which he seems
to know a lot.e (D returns on the 7th and reports that there
are United Nations advisors here telling the Gov't of Pakistan
what to do about boats for best usage in different parts of
the country. D has made arrangements for one of these UN mem
to call on us...In looking at the map with D, it appears

that we may have been a little hasty in saying no to the

8 ft draft quarantine boat...

D reports that he has made arrangdments to have the
biological (public Health )laboratory here activated and that
he is proposing that the CRL have an intimate realtionshép
with it. I assure him that we will do everything possible
to collaborate byt that he must rememeber that neither
JLS nor I are essentially laboratory men.

July 7th..get authorization to have 150 rupee cash advance
for minor expenditures...Sayyed Ahmed is responsible for
this...he asked for 200 but got cut back to the smaller
amount until such time as a year's experieme may indicate

at th eed is for a greater sum.
i © nee sre 8 Sums | ,.authorize the attempt

to get the offices on the top floor fixed up for operations.
It is believed that the administrative offices should leave
the second floor space for laboratories which may desire
access to the patients to be on the ground floor.

I t should be noted here, that as usual, there were certain
misunderstandings, or at least varying positions taken when
a lengthy discussion occurred regarding the Nutrition af-
fairs. It now seems that Cm did not see the Vice Chancellor
as he had expected but did talk at length to Kamaluddin, who
waw able in spite of my admonition to Cm to be on his guard
to convince Cm that it was Cm's place to propose that funds
shovéd come directly from the American Embassy to the Univer~
sity for the work in KA's laboratery and Cm was so far con-
vinced that he wanted to talk with the disbursing officer of
the Embassy regarding this possibility...JLS and I both in-
sist with Cm that he should under no circumstances becomg the
ca&'s paw in the contentions between the national and the
provincial authorities...That Cm is not ina position to
discuss any changes in the signed ageeement with the GOP
ntil such time has he has definite instructions from the NIH.
eceseGM has begun to realize some of the difficulties which
are just around the corner for the nutrition project and
would like to prevent some of them if possible,,I repeat the

suggestion that Arnold Schaeffer should go to J
read the CRL agreement and then look oe my levees eaades:

an autonomous agency operating under a committee of inter~
ested individuals from the Ministry of Health, the Ministry
of Agriculture, the Ministry of Education, etcecescsccseees
July 12 1961 Dacca to Karachi. Enroute to the airport

JLS gives me thetter of July 6 from JES.-This indicates

that there may be some possibility of getting a independent
status established for the CRL....Talk with Mr. Mayhew, a
construction man from Chittagong on the PIA 101 flight..

M assures me that an interested organization can get immed-
jate delivery and shipment of goods and equipment from
Chittagong....he has been doing it for the mst four years.
eeeICA transport leaves me abandoned at the airport for some
time..find Caleb just ready to go home asI arrive at JC's flat.

July 331, with Ted Owens indicates that he hopes to get action
from Ministry of Finance on the modification of the CRL agree-
ment tomorrow...conversation later with Ms. Dhamee indicates
that this optimism may not be justified since, although the
Ministry of Health has given its approval in wrtting, not hing
has been heard from the Provincial authorities in Dacca. (D
says that he is all for the program as I have outlined it,

now that he understands what it is that the NIH has in mind..
that is to say my mind.) I promise D that I shall stimulate

a reaction from Dacca. (This I do later on July 15 by calling
on Additional Chief Secretary Haque and askinghim to check

on communications from the Central Government relating to

the amendment and to the %Revision.)

Consutt Iffy Rogers about the possibiligt of ICA taking
over the receipt and transportation of UK materials at Chitta
gong for our account as part of ICA support..IRogers says this
can be done...

JC and I have a session with James Killen who says he
backed my position with JES, insisting that there must be
something more than had been indidated by Cummings Grant and
Mills..JK admits$that JES admitted that some of FLS measures
were not entirely those which might have been expected of a
properly respectful subordinate. JK advises if possible to
go to the Mynister next with a final document ready for GOV'T
approval..

Visit the Director of Health Yerviees, Brigadier Sherif.
At one point Sherif asks me if I feel thateventually the
work of the CRL might expand to the point where a special .
building might have to be constructed to house its activities.
I assure hig that the probabilities are that, once a base for
research has been established, expansion will occur, and
the government being willing such expansion would obviously
not be limited to what can be carried out in the present
quartdrs. I also indicate thqt we cannot afford to be in-
diffewent to the pbans for the construction of a teaching
hospital (communicable diseases) on grounds close to the
Institute of Health. The CRL and the NIH would be interested
in seeing such construction being adapted to the needs alee
of medical research.

Haque and ask his attention to the matter of getting an
answer back to the Central Government on the queries from
GOP on amendment and revision of the CRL agreement.
Week of July 16 to 23. Dacca..

No effective diary kept during ‘the’ week
week. Items remenembered;

a.Cassanos reported on saturday thet
Ted Ovens had finally sone to the |
Under Secretary of Finance. Mi... --|{--
and found that he knew nothing of |

the proposal to use Trust Funds for
Cholera Research; thet thepapers

had been sent back to the Health |
“Dept to indtiire if it was fPitting ©

and propoer for these activities to

be financed-fron Trust. Punds.Of 1
course Dhanee had not seen the nas!
pers but promised to do so; of
course Dhamee had to choose the
next day to be ill, etc...but the
“panérs ope now back at the Ministry
of Finance and may well be signed |
“BOOT vee _ |
b. Adatianal ‘Chief Secretary Huque |
tells me of his interest in one_of|
the candidates who is to work wi ith
the CRL; also reports that he has ,
sent the proposed revision back tot
Karachi with a note of approval. |
-(hoparently the Trust Fund »,apers -
never came to tic Provincial level)
ec.No further communication from |
JES of proposed SEATO arreement;I
finally write pointing out that at:
a time whén the newsbapers are res]
porting President Ayub's adverse
eomments on SEATO-te President -JFK
it may not be highly propitious to}
push the tie up with SEATO. But

even more fundamentally, there are!
good reasons for not getting the
‘téchnical CRL too closely tied in |
with the actual mechanism of any
politieal organization. Attention )—-
is called to the fact that INCAP.

is really a legal entity and that |
there is nothing to prevent the
USA the UK and the GOP from making’
‘the CRL equally independent and
able to operate uned its om ctean.

Shee eee eh
ia
July 26. Dacca.. As planned I go with KAMansur to visit the laboratory for
the manufacture of cholera. vaccine.This laboratory under the direction of
Ataur R Rahman is supposed to be geared to the production of 8 cruores (80
million) doses of vaccine annually. Recently it has been decided that the
vaccine produced should bed a four-fold vaccine with T A B and cholera!
AR has protested that he is not equipped for such increased production and
KA M hasbeen asked to look over the installation and come up with recommenddf¢rh
ations. (AR says that his present production of TAB is about 50 006 doses
monthly as a maximum, but varies in accord with the demand. The TAB vaccine

is produced for sale whefeas the distribution of cholera vaccine is free.)
The visit starts quite naturally at the bottle washing service, where flasks,
sealed ampules, and ex-beverage bottles of all kinds are washed. The ampules
are made locally from glass tubing imported from INDIA; the local. packing is
not too good with the result that about 2% o£ ampules are broken before washing
begins. Broken ampules are discarded.... Beverage bottles are purchased from
contraetoors for 8 or 9 annas each and then have to be thoroughly cleaned, in-
side as well as out....thé y are of course irregular in size and shape and
color...-Their use as culture bottles meqns they hiive to be rolled by hand
to get a wide surface for bacterial growth; KAM insists also’that the amount
of agar needed for these bottles for a given amount of surface is much greater
than is the case with the wide flat bottles made for the purpos which also
have the advantage in stowage. The round bottles are rolled by hand on cakes
of ice for ceoling.The collection of autoclaves in use, and in disuse is very
striking; Maay in use are electrical;some which were electrical are now being
heated with kerosene burners. Othe dry heat wterilizers are being heated with
burners in a room which is too hot...really too hot for humans to work more
than a few minutes at a time. (Since the containers are known not to be atr
tight sterilizatoon which should take one hour is being continued for two,

three and in some cases four hours.) There are now 26 sterilizers or autoclaves
in operaton, fired electrically or by kerosene burners. Considering this oper-
ation and the cost of electrical current, together with the needs of other
parts of the INSITUTE it is difficult to jestify the absence of a boiler room
and the distribttion of hot water throughout the Institute. Inoculation of the
culture material occurs in three rooms...-During the Monsoon sea:on of high
heat and humidity about twenty percent of the cultures are discarded because
of contaminatéon....The filling of ampules occurs in a Réeetidis vacuum tank and
seems adequate...The attempt to label the ampules is primitive and the packaging
is woeful; 5 % breakage in transportation to the field. (It is obvious that
East Pakistan cannot afford to continue with the manufacture of vaccine under
the prdeent conditions; nor is there any resonable way in which to get the
4-fold vaccine under production here without making arrangements for reorgan-
ization of the laboratory and the installation of cnsiderable amount of import™
ed equipment.)

 
Dacca - East. Pakistan:
July 18.1961:

Dr. Berwyn F. Mattison MD.

Executive Director

APHA New Yorke iW Y.-

Dear Dr. Mattison:.
Some days ago I received your note requeeting re-
commendations for. regognition of workers in the health field for use
by Dr. Leona Baumgartner, who is apparent ly on & committee fer a new
award to be granted by the APHA. |

‘Without knowing too mich about the conditions of
the award I am coming up with the names of two citizens of the Unizad
States who have dorie outstanding work with the ‘international health ,
organizations. I say organizations because I am under the impression
that one has been on the payroll of the PASB and the other on that of

the: WHO> 7 The first name I would propose is that of Nevin
Scrimshaw, M.D. Ph.D. M.P.H. who joined the staff of the Pan Ameri-
ean Sanitary Buréau in’ 1949 as the Chief: Consultant in Nutrision, just
at the time that the PASB was beginning to function also as the WHO
Réfional Organization for the Americas. Dr. Scrimshaw was assigned
immediately to the position of Director of the Institute of Nutrition
of Central American and Panama.’ INCAP had been dreamed up in 1946
with a somewhat limited program in biochemistry in which the Kellogg
Foundation and the countries of CA and Panama were to collaborate in
sewebés the bio-analysis of lowal foodstuffs under the administrative
guidance of the PASB. When I learned of this project after becoming
Director of the PASB in 1947, it seemed much more important to me to
develop INCAP on as wide a scale as possible, rather than to use the
limited sesources of the PASB in attempting collaboration with the
countries of the Americas in programs on the basis of then existing
knowledge. Scrimshaw proved to be a tremendous combination of tech-
nical training, inspiring leadership, and salesmanship; the record I
feeld justifies the decision to concentrate very largely the efforts
of the PASb during a full decade in the INCAP development. It is

to be noted that Scrimshaw developed the program almost entirety
with personnel frm the member states; also it should be emphasized
that although Incap has become known all over the world for its
scientific work in tropical nutrition, it has served over the years
as the coordingating and stimulating cermter for nutritional work

in the six memberstates...It seems appropriate at this time, when
Dr. Scrimshaw has finally acceded to the pressures of MIT, to give
some recognition to the outstanding work he and the PASB have done
in helping seix countries to develop a program which none of them
dould have attempted alone. (1 believe it is sound to revognize from
time to tige out standing work done by international civil servants
at levels below that of Directors-General.)

The second name I would suggest is that of
Ruth Puffer, who had an outstanding career in statistics in the US
before joingng up with the Pan American Sanitary Bureau about ten
years ago. (I frank}y do not know whether Ruth's salary is paid by
the PASB or by the WHO; Ruth has served the intersts of both organ-
izations with hearty seal wherever and whenever there was an oppor-
tunity to promote the production of statistical activities.) Dr.
Puffer has during the decade done more to develop the collection of
worthwhile statis cs on mortality and morbidity soughout the
Americas than I haa ever imagined could be done. An outstanding
development has been the creation of the International Statistics
Service (I have forgotten the exact title ) in Venezuela which is
now financed by the Venezuelan Gvoernment. (Over)

As an additional responsiblity Dr. Puffer has been active in the
preparation of vital statistical material for the PASB, for the WHO,
for Congressional Committees and for International Conferences such>
- as that of the Organization of American States befiug held in July
or August 1961. Ruth has been able to get more interest. in and
more funds for. the development of statistical work in the health |
field than any one else. The importance of. book keeping 6ér health
services is of essentially the same importance “For banks! I
believe this is a suitable occasion to recognize the. ‘qutstanding
work that Dr. PuSfer has done in the internatio nal. field. I would
suggest that more detailed ‘information could be readily supp lied

by Dr. Myron Wegman, who ‘during his years with the PASB was: thoroughly
familiar with Dr. Puffer'ts activities.

Please advise Leona that. her leteer requesting information or
suggestions on Brazil reached me by slow mail with the result that
she was in ‘Brazil before ‘I knee she was going.

‘Sincerely yours,'-
‘Fred L. Soper, M.D.
July 31:

Received suggestion that the Cholera Research Laboratory
should be a SEATO project with. SEATU writing a research agreement
with the NIH. ‘At his request 1: discuss this matter with
Mr. Archer Bloggs 1 agree to write out a note for discussion.

Telephone call from J. Cassanos in Karachi who says that
he will wait to hear from me before taking any Posen.
on the SEATO recommendation.

J. Cassanos says {he document regarding the use of Trust
Funds is in his hands; a copy will be sent to us this week.

Visit of Brig. Hyder and Col. Mallick and 4 of the adminis-
tration chiefs of the Health Services, as well as doctors Ataur Kahman
and Sayyed Ahmed for discussion of Cholera studies. I indicated that
we are interested in knowing where Cholera is when it is there, and
also where cholera is when none is being reported. As the first
step in this epidemiological observaticn it is proposed to have
in the hands of each health officer, some bottlé*of culture medium

which can be very simply inoculated with a rectal swab. Once the

inoculation has been made the bottle is to be placed in a mailing
tube and sent by post to the Cholera Research Laboratory for diagnosis;
Cholera or Not Cholera. ( Since the culture media is selective, no
other diagnosis will be attempted. )

B.H. seems very much interested in the opportunity to get
diagnosis of suspect outbreaks ( Not cases) and asks us to meet with

\

the large group of Health Officers called for the 18th of September.
(2)

After visiting the various parts of the laboratory we go

to 640, Dhanmondai for fruit-juice and cake.

August Ist:
on THE

Yesterday JLS and I called L-invite Consul General, Mr. O'Donnell.
CWE returns from the USA.
Talk with B\sod once nore and given him more definitely my
reaction to the SEATU proposal. I /eavs with the impression that
he is more favourably inclined than pé I to go along with
it. I draw a diagram for him which I am unable finish becasue there is
no logical way to bring 3 countries to TESKE “under an agreement here
with one of them making a separate agreement with SEATO regarding
the entire operation!
August 2nd:

Talk with CWE regarding SEATO proposal. CwE thinks as had I
Thal this 18 WoT, a workable agreement and that probably I should have a
face to face encounter with those who have made the proposal.

Telephone call from J. Cassanos regarding Trust Funds which
cannot be REL EOSER according to Curtis, the controller, without the
preparation of a budget of some eenes, ( I fagk for the instructions
in writing as to what is wanted.)

I tell J. Cassanos of CWE suggestion and get from him Siegel's

opinion that the D Council I would set up would be a very legal body.

Indeed.
FLS DIARY NOTES

August 10, 1961
DACCA.
Spent most of the morning with the Deputy Secretary
of Health, Mr. Zaman, completing a working document covering
the revised draft Agreement of May 10, 1961 for discussion by
the Provincial Authorities concerned viz. the Additional Chief
Secretary and representatives of Health and Finance.
At the Deputy Secretary's suggestion, I write to the
Additional Chief Secretary suggesting an early meeting of the
interested parties and offer to attend in order to clarify any
points which may seem obscure.
Discussed with the Financial Liaison Gfficer, Mr. Moazgzam
Husain,a resource of Public Law for HéO (104-K} Funds. The basis
of our discussion was a copy of '" C.1. AGRICULTURAL TRADE DEVEL-
UPHENT AND ASSISTANCE ACT UF 1954, AS AMENDED dated Sept. 21, 1959"
from the Consulate and a copy in his possession of the Agreement
between the Government of Pakistan and the United States of America
authorising the utilization of certain funds including 104-K as
the United States might decide. A thorough study of these documents

seemed to convince Mh that the subject did not require further

consideration by usif'
4u,ust 16, '61.
_DACCA (E.F.)

FLS DIARY NCTES
Spent the morning at the Eden tuilding.
beputy Secretary of Health zaman and I completed the
draft of a working paper for discussion by Frovincial Authorities of the
Revision of the Agreement of CUctober 14, 1960 proposed by FLS on way 10,
1960. ( This working paper is in general in line with my opinions although
I had to give in 2 or 3 points. Une of these was of course tie matter of
ownership of equipment after the a;reement ends and the other was with
regard to the administration and operation of the hospital which I fully
realize must be in the hands of the Cholera kesearch Laboratory.) zaman
plea to
writes a very strong #¢dfl¢ for making it possible fattract Doctors in
Government employment into service with the Cholera kesearch Laboratory.
I write a note, 6h Z's suggestion, to tne Additional Chief Secre-
tary (Haque) telling him we have worked together on the draft parer and
offering to be®vallpable for discussion of the revision and the working
paper any time he may desire.
Discuss question of !L 480 funds 104 K with Mh. liussain and
we finally agree that FL 480 % funds really do belong to the USA to do

with as the USA may desire.
& 15
Au,ust 14/ 1¥61.

FLS DIARY KOTES _ bpaCCa.

August 14, '61.
National Holiday, Independence Day.
Spent the day largely on the "Eradication of tuberculosis"!

paper.

August 15, '61.

In the A.isx. attend an opening meeting of the Conference
on Communications Media. The present government is taking many useful
measures in developing means of communication with the population,
especially the rural population.

Cette advises by telephone from Karachi that he did not leave
on the plane which came down in Jaipur as we had thought; that he did
see Arnold Schaeffer on Monday and is remaining in the West until Thursday
in an attempt to get the nutrition agreement signed.

Meeting in the evening at the home of the Schimmels: Moore and
Thomas of the Ford Foundation. Aslso Dr. Kab who confirsis my impression
of the A-ray I saw last week.

in the afternoon I received the official copy of my letter to
the Additional Chief Secretary of August 10, proposing a meeting for the
discussion of the proposed revision of the agreement of October 10, 1960,
and a call for such a meeting in the Office of the Additional Chief Secretary

tomorrow morning at 0830.
August 16, 1961.

FLS DIARY NOTES DACC A.

Aug. lo :
Leeting at U&30 in the Office of Additional Chief Secretary,
K.A. Haque, the others present being the Additional Chief Secretary,
brig. bheU. Hyder, Mr. &.A4. Khan, the Secretary of the Finance Department.
During the discussion of the 5 page document the Deputy
Secretary of Health and I prepared together last week, I pointed out
that a full line has been omitted from tue first paragraph of P.5;
the line omitted was the 5th line from the bottom of the paragraph
which proposed the exclusion of the employees of the CkL from the
application of the Government Regulations relating to approval by
a committee for rates of pay for persons secunded to foreign organizations.
I also called attention to the fact that sub-paragraph 5 contains
a statement which is true but is not mentioned in tne revision as stated.
in the discussion of the revision Hyder says that there will be
no occasion fer hiring field staff for the Cxl since tehas more people
what
than he knowsyto do with. I am not convinced that his people will be
( nor p
able to get all of the specimens we want imorderte/ ..1... those shecimens
adopted to tne needs of the epidemiological section.
Brig. Hyder and the Additional Chief Secretary converse at
length over a short document whicn 5.H. had apparently prepared after
which the ACS sp@Ke of impossibility of giving control of a hospital
tc someone other than the Health Services. The “CS nas tne idea chat we
need a committee to control operation of the nosnital but “aman, who Zs has
joined the group shortly after the discussions start pets bhi to say that

what he really wants is a voice in the operation cf the hospital himself.
(2)

Contd. from August 16, 1961 FLS Liary Notes.

 

Z and I agree to work up a draft on tais point and we get an
agreement from the group on the other points discussed, namely, ownership of
equipment and the payment of bonuses te employees of the Cai.

In tne disucussion of the hospital administration it becomes
apparent that 2 and I came out of the meeting with different understandings.
So we returned to BH's office and found indeed that there is a’ misunder~
standing! iiowever, it seems to be all cleared up when I learnt that the
real cause of Bi's interest in this problem is in being able to use the
hospital for a certain amount of training of his own personnel. 1 pointed
out that if he gives us the best he has, we can do something for them in
periods of a year or longer, but that with poor personnel, we have no
opportunity to help hinsebkéyor help ourselves. We agree that the chceice
of personnel to be seconded to the CRL hosjital will be selected by
bil and the virector of the Laboratory.

August 16, Cond:
I finish the draft of the Frovincial vovernment position at

the CRL in the afternoon.
FLS DIARY KCTES

August 17, 1961.

Early to the office of mW Ur. gaman, the Deputy Secretary
of Health tc gresent the result of my efforts yesterday in drawing up
a position paper for the Government of East vakistan on the proposed
revision (dated May 1Uth) of the Agreement of Uctober 14, 1960.

I find Zaman pushing really hard to force us to pay for the

further costs of adaptaticns of tne building for the hospital and for
the laboratory. Zaman calls on nis financial man and shows papers
indicating that there has already been spent some 280 thousand Kk. against
a commitment to spend 220 kss waman says that he does not know whether to
yet the money for the new changes asked for which he says will amount to
sone 3 tu 4 hundred thousand i:

I pointec out that ,anf compensation for the additional expen-
ses on building, the government has not made the £5000 monthly available
to the Director and that the balance of the 15UuUuU &3., for last year (fiscal)
must be very large.

I pointed out that notaing was done about the hospital between
December 1960 and March 1961; that I was seriously promised to builethady
for the nospital during the third week of sarch but that only very recently
uas the work on the electrification been wore or less comoleted.

& and i try to find a way to justify this expense from is. funds
including the present use of goverment funds during the interim -eriod
but fail tc find a loop-hole. ( I insist to tie end I cannot lay down the

wwds

bars and spend US Cougress appropriated dos ues for building construction.}
Continued from August 17, 1961 Fluo LDIAKY NOTES

We finally make minor changes in wy document, charges which
in no way alter the -ingfenfy 1 nad in writing the revision and the
draft position paper.

= says he will get immediate action on this paper and that

it should start to Karachi on tne 19th.
FLS DIARY NCTES

august 17, 1961.

News item in yesterday payer reports cholera in Sarawak;
some days ago the voice of america reported cholera in China.

A woscow news item in the Pacca paper : i:cscow, 4u,tst 12th.
"The tsckK conquest of malaria, smallpox, dracunculosis and other
parasitic diseases will be the subject of an International Health
Conference in Tashkent next month.

Public representatives from India, the ULAR, the Sudan, Kenya,
Ethiopia, Afghanistan, Japan, Chile, Cuba, brazil and Venezuela have said
they want to attend."

Another interesting news item refers to the +L 480 agreement
with Pakistan wiuich has been altered again to include 1250GU tens of
wheat, ($7,700,000), Vegetable Cil ($3150UU0) with transportation costs
of $1,75000G. '' As usual about 80% of the sale proceeds of tue commodities
in takistan *s will be given in the form of loans or grants in project
assistance." ( The report does not say so but the FL 480,¥

NoF 104 K funds cone from the other 20% which is retained for
expenditure by the Us Government.)

This afternoon we receive a cheque for «..30UUL signed by Alice
Jackson; this should keep; us going for a short reriod of time considering

the fact that we have become accustomed to not spending money.
August 19th, 1761.
DACCA.

FLS DIARY sULEkS

Saturday :
Sarly to the bank to depusit cheque for '.30,000/- from
IGA for staff and operating: expenses curing the interim , eriod.
Dr. Sayyed Ahmed tells me that he still tuinks he should
be given an offer of a position by the CRL. I tell him we have not
made any decision regarding technical staff and will have to do so
in concurrence with the iirector of health Services.
Valk with S.A. and learn that he was at one time responsible
for the anti-mesquito surveys (Services) in Dacca. he found it impossible
to check the work of the men in their areas; finally hit on the idea

7

of judging their work entirely on the basis of field checks of mosquito¢s
than all

breeding rather/by direct checking ¢f the workers while at work!

Says he is not inaccord with the present anti-smallpox
campaign which claims to have eradication as its aime 5A would make
it necessary for everyone to have a certificate of vaccination inader
to receive pay, purchase, transportation or any official action whatever.
Also he would pay f¢ vaccinators according to the number of persons

vaccinated with checks being made in the field as to the number vacci-

natedo
John C. Moore Corporation, Rochester, N. Y¥. Binder and holes in leaves Patented. FORM 409200
. UU na }
onic

{FCI
fugust 20 Daeca Sunday...Day at duty on tbe paper; on
letter on syphilis eradication to L. Baumgartner wnon Terry
has made chief of task force to tell how to eliminate this
disease as a public health problen!!!!

Jim Cassanos calls to bring news regarding the
legal status of the CRL according to the Revision proposed
on May 10th. Sierel has decided that the opinion given me
by Cassanos by telephone and quoted by me in letter to JES
of Aug 3 was not his. (This ppinion had been requested by
the cable of some weeks ago asking us to procecd to negot-
4fate:I had asked Siecel for an opinion andhe had tonded to
side with my opinion but not firm enough for quotation. )
At least JC's quoting Siegel and SOBER quoting Cassanos
did finally smoke out an opinion.)...Siesel did suggest
that CRL might be authorized under notional law as an ele-
mosenary institution, or by presidential decree; or and
this would be better from our standpoint, the Revision of
three months ago micht be redrafted with a definite declar-
ation of the status of the CRL and establishing ahd list-
ing its juridical powers as a legal person. Siegel would
orefer to see the CRL established under Pakistan law but
FLS insists on maintainen maintenance of internetional
status. (FLS would not object to a law authorizing the
internstional organization to operate within the country
except that this would establish a precedent which might

anper activities here or in other co.ntries later.
 

ICA 5-8
REY. (9.56)

REQUEST AND AUTHORIZATION OF OFFICIAL TRAVEL
ERNATIONAL COOPERATION ADMINISTRATION

AUTHORIZATION NUMBER
DA 122

DATE

August 22, 1961

 

 

1. NAME AND ADDRESS OF TRAVELER 2. STATUS OF TRAVELER

Dr, Fred L, Soper [J OTHER (Specify)
National Inetitute of Health, uSOM/P | 3 OFFICIAL STATION

 

(1) ADMINISTRATIVE EMPLOYEE NIB Empl oyee

Dacoa, Pakistan,

 

4. This document becomes an authorization of official travel only when the certificate of authorization has been signed by the designated authorizing
officer. This travel is ordered on official business for the convenience of the government, Vouchers should be submitted promptly as provided in

the applicable regulations.

_ 5. APPLICABLE REGULATIONS: Travel and necessary expenses are authorized in accordance with the

(7 ICA Manual Order 560.2, [] Standardized

Government Travel Regulations, and the maximum per diem under these regulations is allowable unless otherwise noted in item 6.

 

 

6. ITINERARY, PURPOSE AND SPECIAL AUTHORIZATION

Purpose: Consultations in ICA/W and NIH*regarding SEATO cholera Laboratory,

Itinerary; Bongkong/Washington/London/Dacca,

Period: Travel commencing on or about August 24, 1961.
Per Diem: Payable by NIH in accordance with SGTR
Beguege: 068 gross accompanying,

aG points of traval shown in itinerary,

 

7. APPROPRIATION LIMITATION SYMBOL 72-FTW891 ALLOTMENT ACCOUNT SYMBOL

 

REQUESTING OFFICE SYMBOL .
Personnel Officer OM

  

 

 

 
     

 

 

 

 

 

with Personnel Officer OM Nov. 4. 196 *
° "| Obl. # 1634 all DATE: Nov
8.
we G, Melollh =~ DS
Other Required Approvel
9 CERTIFICATE OF AUTHOR —f CERTIFY that this authorization has been approved as indicated in item 6
. / 7
Cg
I : =s Assistent Director/Menagenent,
(Signatgfe of Authorizing Officer) “Witte

 

IMPORTANT—Every Houcher and Message Concerning This Travel Must Refer to Authorization Number and Date at Top.

COPY FOR TRAVELER - SKE REVERSE sIDE
 

 

ICA t AUTHORIZATION NUMBER

REV. (9.56)"

REQUEST AND AUTHORIZATION OF OFFICIAL TRAVEL

 

 

 

 

 

DATE 2 Poe ESE
ee ee: Hr 2 eee
RNATIONAL COOPERATION ADMINISTRATION .
aME AND ADDRESS OF TRAVELER 2. STATUS OF TRAVELER

(J ADMINISTRATIVE EMPLOYEE
Pe EE og RE fA OTHER (Specify)
BRU a 8 Rt 3. OFFICIAL STATION
gF we Weg» eb ROK cade

 

 

4. This document becomes an authorization of official travel only when the certificate of authorization has been signed by the designated authorizing
officer. This travel is ordered on official business for the convenience of the government. Vouchers should be submitted promptly as provided in
the applicable regulations.

5. APPLICABLE REGULATIONS: Travel and necessary expenses are authorized in accordance with the [] ICA Manual Order 560.2, [] Standardized

Government Travel Regulations, and the maximum per diem under these regulations is allowable unless otherwise noted in item 6.

 

6. ITINERARY, PURPOSE AND SPECIAL AUTHORIZATION

 

 

 

 

 

 

 

 

 

ae
7. APPROPRIATION LIMITATION SYMBOL - ALLOTMENT ACCOUNT SYMBOL REQUESTING OFFICE SYMBOL
Wawhy 4 Sut OTS AM a ce tenge ath seer aMe sek Eo Rk
Poeesernah 6 fo poe Lo Pay Sg LED
DATE: ~‘**
8.
dott hic bg LeLLe
(Signature of Approving Officer) oe LL & Log.
bed seed de Paakahs £ it’s Other Required Approval

 

(Title)
9. CERTIFICATE OF AUTHORIZATION—I CERTIFY that this authorization has been approved as indicated in item 6

 

 

 

 

 

 

 

 

 

 

 

 

 

ee etie PA bee Stoes nou) aeeae
(Signature of Authorizing Officer) (Title)
TYPE FOREIGN CURRENCY ESTIMATE q- —> U. S. DOLLAR ESTIMATE
OF USE FOR AMENDMENT ONLY ESTIMATED OBJECT USE FOR AMENDMENT ONLY ESTIMATED
CURRENCY INCREASE DECREASE COST (NET) CLASS INCREASE DECREASE COST (NET)
, PER DIEM
ALM, [kt AND TRAVEL
021
030
TRANSPORTA-
TION OF
+ we THINGS
TOTAL
ow | «—->

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT—Every Voucher and Message Concerning This Travel Must Refer to Authorization Number and Date at Top.
_, Pa oe ~
Iola Kanszg
Saturday Sept 2 1961

   

7 ‘4 ;
Dr. Joe Le Stockard, M.D. ] FE /
tholera Research Laboratory TOK «
Dacca East Pakistan. J) oem
J
Dear Joe: Uy

Just a line to keep you up to date with happenings outside of
East Pakistan....The stop in Calcutta was uneventful except for the last
minute discovery that I had failed to have Miss Middleton enter my recent
vaccinations, especially the vaccination against cholera on my yellow cer-
tificate, althouch I had made special trip to her bailiwick to get Juliet's
vaccination properly recorded...I shall give you later the denouement!!!

The Caplans travelled on the same plane with us to Hong Kong
as did also Mrs. Wong and the five children....the Caplans spent two days
in HK and took the sam plane to Tokyio...In Hong Kong airport at time of
departure we found Dr. and Mrs. Warren Weaver, previous to retirement a year
or so ago a Vice President of the Rockefeller Foundation...and on the plane
frog Hong Kong to Honolulu, a Mr. MCCulloch of the USPES and ICA whom we had
first met in Hangkok some years ago....50 you see we felt accompanied most
of the way....

In Hong Bong we were not met as the Consulate had requested,
because, it appears, my name was given on the cable as Dr. Fred Soper Ming!
However, the Hotel Miramar runner picked us up and later in the evening I
got in touch with Dr. Colfer of the USPHS on duty in Hong Knog who gave the
glad tidings that the next day, August 30, would be a holiday with Gov't
offices closed......So there was nothing to do but get out and look and shop
until ones money and feet gave out simultaneously....

At the Medical Service I found Dr. David Mackenzie, to be the
same Dr. Mackenzie I had first mt in Africa som years ago..we were later
together at one of the World Health Assemblies. He appreciated getting the
note and the news from the Blackies, Dr. Mackenzie, Dr. Franklin, Dr. Alurez
and others were most helpful and I came away with six cultures,two from the
begin ing of the outbreak, two some fifty diagnoses later and two of the
most recent. I inoculated two of the Mansur eultures from cultures and two
with rectal swabs of the most recently diagnosed cases.

When I was in HK there had been 11 deaths in 98 cases:today's

Kansas City Star reports 12 deaths in 10) cases, There was a declaration in
the Knog Kong paper from Canton insisting that there had been no cholera in
C’mmunist China but that there was an outbreak of para-challera due to elTor
vibrio, The outbreak in Hk is all due to the same organism which seems to be
a mild OGAWA strain of vibrio. Mackenzie is inclined to believe that the out-
brak in China is an extension northward of the ottbreak in northern Tailand
las January (Decwmber) wich prevented the appearance of Felsenfeld in Dacca.
I believe there was belief that that outbreak may have been due to the ElTor
organism, In any case a great deal of interest is attached to the proper
identi@ication of the H ng Kong organism,

The flight’ from Tokylo was via Wake, as I understand occurs
quite regularly when PanAmerican is able to sell a hrge number of seats and
thus has reduced capacity for fuel, Thus we arrived in LA teo hours lage
and found the airfield fogged in although the rest of the area appeared
clear, We landed at Ontario fifty miles east of LA and drove in by bus
getting to bed at 000, with reservations onward set for 091,53}

Kansas has been cool during August and everything is still
sreen and the cattle all look fat and well fed in comparison with others
we have seen recently; none of the corn has been fired and mone of it is
yellow, between KC and Iola nor between Iola and Wichita.

Enough; duliet joins me in semiing our best to yoo and Ann,

Sincerely yours

Fred L. Soper.
(26 April 1965, mnc)
Original dated October 1961

tee Lb
\ t mk } a

PAKISTAN@SEATO CHOLERA RESEARCH LABORATORY
Dacea, East Pakistan

Astounded to receive two cables same day (October 12th) regard-
ing CRL participation in cholera epidemic in the Pacific; the one
suggesting the Deputy Director of CRL be offered to the infected
country and asking CRL opinion of sending additional diagnosticlans
from the USA, the other advising that NAMRU is moving in on the lth
inst., that NIH is moving in with Feeley of NIH and Smith of Jefferson
for three weeks bacteriologic research, and that, if feasible, the
CRL should participate by sending Stockard for three weeks epidemio-
logic support to Feeley and Smith.

On receipt of the first cable, it was thought the CRL might
send Stockard to take Mansur to aid in organizing field diagnoses
with very limited equipment and at the same time establish CRL on
the map in such a way that another nation might be interested in
participation in CRL. This would alse add to KAMs prestige and
that of CRL here and might even influence his continuing in cholera
research.

After checking to see if JLS could leave for a few days am
discussing with Mansur the possibility of his release from commitment
to attend the CENTO meeting in Karachi next week, I was prepared to
cable suggesting JLS and KAM proceed to the infected area, but that
diagnosticlans not be sent from the USA.

The secom cable indicated clearly that nothing could be gained
for CRL relationships with the country concerned and that KAM had
nothing to offer since Feeley and Smith are fully cognizant of the
details of his medium.

The proposal that Stockard should abandon the CRL for three
weeks to give epidemiologic support to the bacteriologists shows a
complete lack of understanding of the conditions surrounding the
very existence of the CRL, or should we say the Facts of Life of the
CRL. CRL is beginning to grow, slowly itis true, but it cannot
simply be abandoned for three or four weeks at the moment of making
changes in the building, of training the administrative staff, and
of getting Government cooperation. Also, the CRL is just now ready
to develop some epidemiologic work in East Pakistan based not on
chasing epidemics in other countries, nor on chasing in to study
reported outbreaks here, but rather on getting systematic routine
collection of cultured material from outbreaks of diarrheal disease
to determine when and where transmission of infection cccurs through-
out the year. The CRL is interested in studying the life history of
2
FLS Notes on Pakistan-SEATO CRL (October 1961)

cholera rather than the life history of epidemics of cholera.
(The Rockefeller Foundation in Brazil began to learn the facts
regarding yellow fever and to be able to eliminate A.aegypti-
transmitted yellow fever only when it ceased chasing and control-
ling visible outbreaks and introduced systematic routine viscero-
tomy to show where yellow fever was when it was there. Let us
not waste fifteen years, as the Rockefeller Foundation did with
yellow fever, and chase cholera in Hongkong, Manila, Sarawak, or
wherever it may be until we have something to offer. Study in
depth the endemic centers. Probably cholera can be dest studied
by

a. Routine school stools when diarrhoea is present,

b. Concentrated study of limited area in known endemic
zone of East Pakistan. Launch trailer census, etc.
(28 April 1965, mnc)

eek

tN Lane -

Plate at entrance, December 5, 1960.

Bacteriological Laboratory working at that time.

l. Bacteriology, for epidemiology of non-epidemic cholera

Water Laboratory: Help solve question of seedbeds of
infection in Delta areas about the Bay of Bengal.

2. Agreement

a. No longer bilateral-technical aid pattern but working
unit devoted to solution of problem.

b,. Mechanism for multilateral participation--DC never
planned for 2 country programs, UK and PR represen-
tatives here.

c. Mechanism for international assistance--to countries
with cholera and to those threatened with cholera.

d. Autonomous agency can receive grants and operate freely
so long as it has confidence of those with the purse
strings.

3. Spidemic of 1961: Macau, Hongkong, Indonesia, Communist
China, and PR very useful.

Thailand invasion, 1958-59, stimulated creation Cholera
Research Program.

Western Pacific invasion 1961 may well serve to consoli-
date position.

Yellow Fever in Ceara in 1923 opened Brazil to RF work.

Invasion of Rio in 1928 resulted in development of
National Service with linkage internationally with
Yellow Fever in all other countries in South America.

Interesting to contrast with Yellow Fever Eradication and
Malaria Eradication the two preceding international attempts
at Communicable Disease eradication.

Yellow Fever: Began with full knowledge and complete confi-
dence. Learned later that YF was not a simple evidemiolozical
problem. Settling for eradication of Aedes aegypti in the
Americas. (Many years before Yellow Fever Service had
its own laboratory.)

Malaria: Began also with considerable knowledge ani demon-
stration of eradicability of malaria. Cholera is beginning
with confidence in eradicahility, but with confession that
we do not know exactly what technique can be used most

advantageously.
Renewed interest of WHO.

lh. 1962 visit of four members of the NIH Cholera Advisory Com-
mittee and two consultants.

"It is vital for the continued development of the CRL that
a senior scientist or public health expert with broad expe-
rience in administration and in international affairs be
recruited promptly to serve as a Director of the Cholera
Research Laboratory."

"ixperience during the past twelve months with cholera in
mainland China, Indonesia, Sarawak, Hongkong, and the
Philippines emphasizes the need," etc.
(28 April 1965, mnc)
Original dated 1962
FLS Notes on No etuey

CHOLERA RESEARCH LABORATORY

Since March (1961)
Recommendations ani Requesta

a. INCAP~Type Agreement
(FLS in the middle)

b. Bacteriologist

c. Water Biologist

d. Against April Arrival of Metzner

e. Information on 3 Horsemen

f. Against firm orders given by NIH on MC's recommendations.

g» Not consulted on date of Gordon's arrival, nor on arrange-
ments for Macliittyre and 3 clinical men next year.

h. Against shipping of Trailer and other supplies at the time.

i. Dollar expendituresunknown. (Rupees expenditures brought
under control except for 35,000 dollars worth of PL 80, but nothing
on dollars.)

j. No Advisory Committee.

k. Macleod, Goodner, Woodward, and Smadel. (Too much Ameri-~
cans at this time!! Metzner came when not wanted and left when
most needed. )

1. Metzner instructed to write back to JES.

m. Gordon sent out with instructions as to what he was to do
until he took over as Directort

n. Gordon had instructions to report weekly to JES. Maintained
MacIntyre as his man.

o. Announced RG as Directors 10 dollar bet. I would not come back.
p. Countermand order for tape recorders.

q. Arranged trip in September, Smade]l and Mills to negotiate in
week or else! Cables sent to Pakistan on trip.
FLS Notes on CRL, 1962

r. FLS against "epidemic" chasings against Stockard to PI for
three weeks. CRL should have brought in NAMRU~-Feeley and Smith if
needed.

s. Feeley and or Smith should be in Daccas CRL mst be "source"
of cholera NIH operations; not a peripheral "source" of things to be
studied.

t. Must accept CRL as rapid development to get what CRL has and
what it is, where it is! (Gorgas’ first trip to Brazil, 1916; RF
began YF work there 1923, or seven years later, and only in 1930,
after another 7 years, was full freedom of action gotten. INCAP
organizational meeting at Tegucigalpa in February 19463 INCAP's first
small laboratory inaugurated September 1919, i.e., 3-1/2 years later
with only three countries. Present building with six countries
participating was inaugurated September 195], another five years later.

ue Priorities: Bacteriology, Spidemiology, Serology, Water
Biology rather than Physiological Chemistry. (Treatment is important
but early and careful treatment is doubly important. In most areas
early treatment will not be available.)

v. Instructed to teach JLS administration to be ready to take
over.

i rep os am

Gordon invaded office and gave letters directly to secretary;
KAM's paper, took over sponsorship without consulting anyones although
he had nothing to do with stimulating work to be reported. (FLS knew
of no funds with which KAM could be sent to USA; JES immediately approved
RG's action and KAM's trip to Atlantic City.

JiS approved Mrs. Schuler as secretary at 4500 dollars per anmm!!
Without consulting as to whether we wanted her or not. Cable authoriz-
ing was of course widely known in American offices. I was embarrassed
no end,

Director had no functions dollars controlled by JES; Rupees by
GOEP, Trust funds only in late August. FILS' resignation really in
June; confirmed in August.
(28 April 196°, mnc)
Original 19626 °° ';

FLS NOTss ON
CHOLERA RESEARCH LABORATORY

RG has shown no interest in administrative matters
has failed to follow suggestions
has free wheeled
is a free wheeling dilettante

Proposal for study is obviously not fundamental to solution of
cholera problem

"DR. GORDON will head the Clinical Research Section and will
be in charge of organizing a new ward. He will investigate the
possible role of nutritional deficiency in susceptibility to
cholera and will also collect data on whether recovery from clinical
cholera produces lasting immunity.

(below)

I offered to set program along his lines of thought, asked for
plans ami program
staff

Full week--nothing--unpacked cases--read papers at Medical Society.
I learned of their progress at midnight, before reading.

No advantage has been taken of our overlapping periods of service.
Reporting directly to you--not to me.

Attention was called early in 1961 te need for bacteriologist;
later I called attention to need for water biologist.

2 men here~--never asked for.

Gordon considers MacIntyre his man.
Gordon said he would not work under JLS; JIS is not anxious to
have administrative responsibility under Gordon.

Need for senior director.

leave JLS as Acting.

"DR. McINTYRE will assist in the clinical and research work.
He will conduct a number of studies including an investigation of
the role of nutritional deficiency and anemia in susceptibility
to chokera."
FLS Notes on CRL, 19627

Director Designate is as ready as I am to take over the laboratory
of clinical research.

1. Reaction has been palpable in Bangkok, in Dacca, in Karachi.
2. Demand of "in consultation with Government of Pakistan."

3. Free wheeling from beginning
Refused to accept identity of CRL
No indication that he ever left his own section in NIH
I insisted on communications through Director's Office;
has not complied.

a. Insisted on going with JLS

b. Told Zaman yes, we could get money for building and
construction costs.

c. Mansur paper

d. Has indicated his continual interest in research and
desire not to be involved in administration.

The CRL cannot operate as an addendum to NIH under care of
Administrative Officer. Must have mature Public Health Service
officer whose primary interest is administration.

The CRL, with this agreement, becomes an institute with unlimited
possibilities with all phases of cholera!!! NIH cannot leave to
uninterested and unexperienced person.

Note of insubordination to be put on the record of %. I do not
care how brilliant RG may be. I will not work with anyone who flouts
all suggestions made by me. I shall talk with RG and report further
to him regarding the situations but when I leave someone in my place
as I did with Dr. Stockard, I treat what is done with him as having
been done with me.
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

 

PUBLIC HEALTH SERVICE

   

BETHESDA 14, MD.

 

NATIONAL INSTITUTES OF HEALTH
OLiver 6-4000

Augu8t 15, 1961

Dr. Fred L. Soper

Director

Pakistan-SEATO Cholera Research Laboratory
Institute of Public Health Building
Mohakhali, Dacca-5

East Pakistan

Dear Fred:

Needless to say, I was sorry to get your letter of
August 8 which firmly states your intention of with-
drawing from the Cholera Research Laboratory at the
end of your year of residency in Dacca or when the
new agreement regarding the reorganization and
financing of the Laboratory has been signed. For
myself and all of us connected with the venture,

let me express appreciation for your great help in
getting things underway.

While I accept the finality of your decision, I hope
it will be possible for you to arrange the timing of
your move from Dacca so that it will interfere as
little as possible with the smooth, continuous build-
up of the Laboratory.

I shall write you in a few days about ideas, suggestions
and plans for restaffing the Laboratory. I want some
time to think clearly on the matter and to obtain advice
from a number of interested persons.

With very best wishes. -

Sincerely yours,

   
 

eph E. Smadel, M.D.
H Cholera Advisory Committee

cc: Dr. Shannon Dr. Gordon

Dr. Watt Members, NIH Cholera Advisory
Dr. Cummings Committee

National Cancer Institute National Heart Institute National Institute of Allergy and Infectious Diseases Nationa] Institute of Arthritis and Metabolic Diseases
National Institute of Dental Research National Institute of Mental Health National Institute of Neurological Diseases and Blindness The Clinical Center

Division of Biologics Standards Division of General Medical Sciencer Division of Research Grants Division of Research Services
Wetienal Inatitutes ui Health
Bethesda 14, Mc.
Auguet 15, 1961

MEMORANDUM

TQ: Members, NIH Cholera Advisory Goumittee
Dr. Burrows
Dr. Cheever
Dr. Goodner
Capt. Kingston
Dr. MacLeod
Dr. Mase
Dr. Pease
Dr. Woodward

FROM: Chairman, NIH Cholera Advisory Committe

SUBJECT: Dr. Soper's retirement from Bacca

{ know that you too will be sorry to learn from the enclosed
correspondence of Fred's decision to return to Washington late
next winter, Indeed, if he 1s able to accomplish the reorganination
and financing of the Laboratory before that time, he wishas to be
relleved of his regponsibilities in Pakistan this fall,

L would welcome your comments and suggestions on the bast
arrangements that can be made to carry on the important cholera

effort which has bean initisted so auspiciously. of
AG ode)

JoSeph BE. Smadel, M.

 

Enclosures

ec: Dr. Cummings
Capt. Phillips
Mr. Jones
Dr. Soper
COPY

Dacca, East Pakisten
August 8, 1961

Dr. Joseph E. Smadei

Chairman, Cholera Advisory Committee
National Institutes of Health
Bethesda, Maryland

Dear Joes

Some weeks ago I wrote you stating that a family
decision had been taken not to continue Living im Dacca
beyond February ox Marth 1962 and suggesting the pessibility
of an earlier termination of my association with the Cholera
Research Laboratory.

I have attempted to make an objective analysis of
the situation here and belfeve it is for the best interests
of the CRI and the NIH effort that a director be appointed
as secon as possible after the Revised Agreement is signed
to operate under it.

nu the meantime, mews has come of iilness in the
family which may make it extremely difficult fer us co be
outside of the United States.

Please take this thea as my formal resignation st the
end of my present appointment or as soon theresfter as necessary
or desirable when negotiations of the Revised Agreement vith
the GOP and cther mations may be complered,

This is the first real letter of resignati
ever written; my leaving the Foundation was an ape mart
to serve with the PASB. I find it difficult to sign off
this project which with a little time and patient nursing
has great potentialities. —

Sincerely yours,

fe/ Feed L, Sopexs

Pred L. Separ, MP.
August 15, 1961

Dr. Fred L. Soper

Director

Pakistan-SEATO Cholera Research Laboratory
Institute of Public Health Building
Mohakhali, Dacca-5

East Pakistan

Dear Fred:

Needless to say, I was sorry te get your letter of
August 8 which firmly states your intention of with-
drawing from the Cholera Research Laboratory at the
end of your year of residency in Dacca or when the
new egreement regarding the reorgenization and
financing of the Laboratory has been signed. For
myself and all of us connected with the venture,

let me express appreciation for your great help in
getting things underway.

While i accept the finality of your decision, I hope
it will be possible for you to arrange the timing of
your move from Dacca so that it will interfere as
little as possible with the smooth, continuous build-
up of the Laboratory.

I shall write you in a few days about idess, suggestions
and plans for restaffing the Leboratory. I want some
time to think clearly on the matter end te obtein advice
from a number of interested persons.

With very best wishes.-
Sincerely yours,

  
    
 
 

Moseph E. Smadel, M.D.
Chaifman, NIH Cholera Advisory Gomuittes
cc; Dr. Shannon
Dr. Watt
Dr. Cummings
Dr. Gordon
Members, NIH Cholera Advisory Committee
De. Martin MH. Cummings, NIA Auguat 3, 1361
Br. Clifford A. Pease, ICA

Dr. Joseph E. Suadel
Chief, LYR, DBS

Dr. Soper's letter of July 26

A thermofex copy of De. Seper's letter to me dated July 29
is enclosed for your informat (oa.

It looks as if in the course of obtaining interim support
from the trust account. Dr. Soper may have established a moat useful
principle in getting the GOP to accept the words as deemed necessary
by the Director of the Laboratory in consultation with the provincial
Authorities of East Pakistan.

A question is raised in the letter regerding the Leve! of the
negotiations which would be required for the Governments of Fakisten,
U.K. and U.5. te establish the CRL as a legal entity.

cc: Dr. Soper
National Institutes of Health
Bethesda 14, Maryland
August 11, 1961

MEMORANDUM

TO; Members, NIH Cholera Advisory Committee
Dr. Burrows
Dr. Cheever
Dr. Goodner
Capt. Kingston
Dr. MacLeod
Col. Mason
Dr. Pease
Br. Woodward

FROM: Chairman, NIK Cholera Advisory Committee

SUBJECT: Interim report

Frustration continues in the effort to make available for
cholera research in Dacca the $400,000 worth of Pakistan rupees
which the NIH has for the support of the cholera work in East
Pakistan. Despite the difficulties, I expect to resolve the
matter before November when some of the visiting sclantific groups
may wish to begin collaborative studies at the Cholera Research
Laboratory in Dacca.

Plans are proceeding smoothly for Br. Robert 5. Gordon and
Dr. 0. Ross McIntyre to arrive at the CRL in early October,

Dr. Gordon will serve as Chief of the Clinical Research Section,
and Dr. McIntyre will assist him, The plans encompass the
establishment. of a physiology Laboratory and the activation of

the 20-bed cholera ward which is located on the first floor cf the
CRL wing of the Institute of Public Health, Much will remalu to
be done in accomplishing these after their arrival in Bacea.

 

SR RO aa tihe ofen fib niin ambont)

Capt. Phillips
DEPARTMENT OF HEALTE, EDUCATION, aNb Veheales

National Inetitutes of Health
Betheada 14, Md.
August 25, 1961

    

RL Aw~ s&
— LS0AR 140

 

Dr. Fred L. Soper

Director

Pakistan-SEATO Cholera Research Laboratery
Institute of Public Health

Mohakhali, Dacca-5

East Pakistan

Dear Fred:

Since my letter to you of August i5, IT have had an
opportunity to discuss with a number of persons concerned with
the cholera program those moves that need to be made in cennece
tion with the completion of your tour in Decca as Director of
the CEL. The group included Dro. Shenanon, Watt and Curminge
of the NIH, and a number of mambers of tne Cholere Advisory
Committee whe have intimate knowledge of the entire situation
and who were available; this latter gvous includec Dra. Pease,
Goodner, MacLeod, and Woodward. The consensus of these cane
versations 1s given in the following paragraphs, ,

Dr. Robert Gordon, when he arrives in Becca, will have
his current title of Chief of the Seetion on Clinical Research,
and ia addition will be introduced ag tho Uivrector-desigiaee of
the GRL, to take over at tha time of your ceparture. It is te
be hoped that a reasonable amount of tim: wthl be availazla to
aliow Gordon to begin putting hos Laboratery and elinical
organizatloa intd shape Dbafsre ne agaumer cha Guties of tha
Director OF cRy,.

LL nae aeaYenaeseepeessianhtARSRED

There are a munber of copent reasons why Gordon Ls to
be cemed ag the Birector-designee rather than Ie. Joe Stockard
who is the Deputy Dixector, GRL, and the Chief of the Boidemi-
olugy Section, In the firs: plsce, Gordon has had more oxpere
lence in research, incidentelly, he was one of the firs: group
of clinicians of the Heart anstitute, ani has done much co
develop the clinical researzh progran gince it first wea
activated in the new Clinical Center a miaber of yeara ape,
Moreover, Gordon has the rank of Medical Director which os the
equivalent to Colonel in the Arey while €tockerd has the rank
of Senlor Surgeon, the equivelent of Lieutenant Colonel.

 
Dr. Seper - 3/25/61

   

that Stockerd should devote almost

development of his Epidemiclogy Section witk its designated
ob of Find ng and following one or more Pakistan! commuiicties

which may be used in the controlled vaccine studies wale? ara
perenne a egret Re ete ee
ao important.

Gordon's prime interest is in clinical investigation,
and he is enthusiastic about the prospects, as they wers
originally conceived, for work in the physiology section and
in the ward. Nevertheless, be is willing to teke on the
additional responsibility of the Directorship of the CAL whea
the time comes, Both he and I know chat che duties of the
Directorship will be demanding, but assume that there will >:
time available for him to supervise the clinical work ever

 

though he will net be able vo take total ratiert responsi bilicy

hinself,

can share the patient load with Or.
arrive in Dacca along with Gorden about aid-Getober, We hava

 
 
 

a reasonably good prospect fer this new clinician in Ix. Linden~
z
&

baum, whom we may be able to gei: to Daces late this year oz
early next.

The pregence of an active yours NEH administrative officer

at the CRL for several mofittis Gh Gaen of 7
the past year hes been se fculeful thet Le has heen de

ed

add such an individual to the permanent cadre s WhO Y

It would be most fortunate if Mr. Metzner, who
on £ temporary assignment ac en edministrative
Laberatory, might be perevaded to return with bh
nermal tour sf duzy. On thea other hsod, if thi
ancther younz administrater who has recently fi
traineeship in Bethesda might be asaiene:! te D

-

   

 

We plan to preceed with cbtadring the formal approv:
rom the various

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revision of the existing agveemeat under which the
operates or completion of the egreewenr for the use ef the
NIE PL~480 rupees for support of the chelera rascavch

lees to say, both the matter of the reergenizaticoa and the:
of the rupees must be sattied in the very Z ;
whetever finel arrangements are made they wi
be supportive of the research plans cutiiae’

 

 
Dr. Soper ~ 8/25/61

Within a few days, I hope that it will be possible to
offer you ideas and proposals regarding the work and personnel
of several visiting acientific groupe who are considering
studies at the CRL this fall. At the moment, the subjects
which have elicited the greatest interest are those concerned
with bacteriological and immunological aspects of cholera.

One of these has to do with serological surveys including the
application of new diagnostic procedures. Another would probe
the possibility that a booster phenomenon obtained with a
single dose of cholera vaccine in a population in au endemic
area might play a significant role in raising the resiatance
of such persona during an epidemic, Other ideas and plars
will undoubtedly come along in the near future. I shall keep
you informed.

Yesterday I sent you a cable through the State Pepartment
asking that you return in early September to assist in renegeti-
ating the CRI agreement here. We shall have an opportunity te
discuss the matters mentioned above at greater length while
you are in Washington.

Very best wishes-

Sincerely yours,

Joseph E, Smade’, M. DB.
Chairman
NIH Cholera Advisory Comaitcee

cc: Dr. Shannon
Dr. Watt
Dr. Cuumings
Dr. Stockard
Dr. Gordon
Dr. McIntyre
NIH Cholera Adv. Comm.
Capt. Phillips
Daces. East Pakistan
Aacust & 1961

Dr. gosevh E, Snadel, M.D.

Chaimar Cholera Advisory Comittee
Naticnal Institutes of Health
Bethesda Maryland

Dear Joe;

Some weeks ago I wrote you ututing that a family decision
had been taken not to continue Living in Dacca beyond February or
March 1961 and suggesting the oossibility of an earlier termination
of ny association with the Cholera Research Laboratory.

I have attemptald te make an objective analysis of the
situation here and believe it is for the best interests of the
GRL and the NIH effort thet a director bo apoointed as soon ag
possible after the Revised Agreement is si: ynod to operate under
it.

Tn the neantine, news has cone of nee s in the fanily
which may make it extremely difficult for us to be outside of the
United States.

Please take this then as my formal resignation at the
end of my ppesent appoirtment or as soon thereafter as necessary
or desirablaibegotiations of the Revised Azreement with the GOP

and other nations may be completed.

This 4s the first real letter of - esignation I have ever
written; my leaving the Fowsxlation was on a: lo0intment to serve tith

the PASB. I find it diffiecvlt to siyn off this project vhich with
a little time and patient nursing has great votentialities

Sincerely yours,

Fred. L. Soper, M.D.