63 Rio. Em. Sur. Manoel Duarte. Dr. Andrade, Dr. Lintz, Dr. Tomaz and I discuss proposed contract frankly. No definite conclusion reached. Dr. Barros Barretto says Fraga is agreeable in principle to mission for investigation of Leptospirosis in north and asks for conference + with Bea gho Friday. é@ragso notified. 5 May 3. Office in AM. Holiday of Brazil. Swim at Post 6 waves strong. Mey 4. Conference with Dr. Decio Pefreiras on malaria. Probable easy solution of malaria situation. Pernambuco notified that he can sail in June. Visit from Dr. Guilherme Silva of malaria service of Minas Gerses. Dr. Henrique Aragao and I visit Dr. J.B. Barretto and talk over the commission te stugy yer Dr. BB says the DNSP is ready to heIp. Dr. H.A. says material should be sent here for study and that he needs time to brush up on leptospira i technique. He offers to buy two monkeys and i start work and I authorize purchase with R.F. funds. Dr. HH promises to work out detailed plans for work of commission to be presented next Thursday when we are to have further conference. May 5. Connor telegraphs of suspect case of y-f. in Timbaxbe (Pernambuco). Telephone to | ] Borges asking for "prents" Braghiosd gprnin Ryd May 6. To top of Tijuca with Capt Babcock and family. Mey 7. Return f lost engineer "Costa" Leite. Accountant comes to check 1927 accts. Advise Dr. LaFayette and Dr. B. Barretto of the suspect case in Timbazfba . Dr. Kerr arrived Asuncion, May 8. Dr. Muench sails on Oraniea for Bahis receive wire from Connor saying nothing pos. | appears in investigation of Timballba case. K May 9, Leave card on Dr. J lematine at Hotel. Visit auto show. May 10. Connor sails from Recife for Bahia. Dr. H. Aragao and I visit Dr. Barros Barretto and talk over plans for commission on study of icterus in Brazil. Dr. HA submits typewritten ge outline of probleps ot be studied by joined forces te at of C.R., DNSP, $%Px-of Bahia and Ins. Os. Cr. Pe- tse. 63 & See lon Chaney in Monster of the Circus. 64 May 11. Wire from NY "Connor - do not understand your letter April 24th. No doubt about diagnosis yellow fever - Case is not Weils disease Russell." | Send report on commission mentioned for study to Russell and Connor. May 12. Gerald Golden, British, from dares bolus Goyaz, comes to office for information regarding Hookworm and malaria. Wire from NY announces } that Davis will sail June 2 to join Connor. ! i May 13. Sunday. Lunch with Consul G. Dawson. May 14. Interview letocoere to see if passage for Muench can be arranged. Dr. Fraga has just returned from Caxambu. I discuss the yellow fever situation with him and tell him of steps already taken by Dr. Aragao. Also tell him of BFFR's attitude toward Course of Hygiene in Rio and give him invitation to go to the USA, He states that action in Congress on Course can be delayed until sfter his trip to US even if he does not go before Sept. I also inform him that Dr. Davis will arrive in June. May 15. Wire from N.Y. asking for "current" to be used by Davis in laboratory list of "currents® in north secured from General Electric. Conference with Drs, Fraga and H. Aragao. The situation of the north is discussed. Why did yellow fever disappear once and for all time in Rio, Sao Paulo and Amazon River when control measures were adopted but fails to do so in the Northeast of Brazil.. All are agreed that studies must be made. D, Aragao is to work up details for conference with Davis on arrival. Also proposed to send one M. rhesus north now. Dr. Aragao is proposing many details including the examination of each town in danger zone every three months.for at least a year after last suspect case, From letter of FFR to MEC Apr. 24. "The y.f. lesions first described by Rocha \ Lima which are necrosis of the midzone cells of | the liver lobtkles are accepted by Klotz, McCallum, | Darling, Callender and others as characteristic i 1 / of y.f.......1 might say that at the present time | ¥ this lesion is the most definite and character- istic thing which we know in the diagnosis of yellow fever." From letter of FFR to MEC Apr. 23. "....No Leptospira have been found in Africa!" | ee ect 1923 Letter FFR to D.W.B. Apr 28. ".,.one of the most difficult problems in yellow fever control, that is, the recognition of cases so mild and aty and so limited in number, that the diagnosis on clinical grounds alone presents great difficulties...... In legos, a virus has been obtained from cases so mild that a diagnosis on clinical grounds could not have been made.... mild cases may occur in adults as well as in children and pung persons... As you know, the American pathologists who have studied the question are quite convinced that the lesions first described by Roch Lima are pathognomonic of y.f. Darling : while still at Panama discovered the same thing : and taught it to his assistants but, so far as I know, never published anything on the subject." Dr. Fraga's attention has been called to work . in Campin? Grande and Alagée grande. Municipal Ee din control checked by state control should be feasible. “ Byrle May 16. Conference with Dr. Fraga. DF asks for use of Costa Leite in Jacarepegua for one or ; two-months granted. I suggest that CR needs i Ropere pss nowren AY i of } new office and that Nurses Residence would be pre ideal, C. F. agrees in principle but suggests thet we take nursing service quarters and that Mrs. Parsons move to Residence. To this I reply that I prefer Residence office. Call on Capt. R.A. Warner. See What Price Glory? May 17. Ascencion Day. No Holiday. May 18. Dr. C.F. agrees to our occupation of Nurses Residence. Visit from James H. Roth. Rotary 221 East Cullerton St. Chicago. Advise Mrs. Parsons that our contract with Federal Government expired April 1, 1928. May 19. Dr. Salles Gomes, Dr. Geo. Hasselmann and Mrs. Parsons visit office almost simultane- ously. Sat, afternoon Dr, Aragao informs that tissues | of Almeida, Timbaywba, are positive. Later I learn of suspect case in Rio and advise onnor and NY, Iate Sat. night Rocha Lima confirms both diagnos£s, Sunday 20, Wire NY and Connor of R.L. diagnos£s; | afternoon in hills with Mrs. Parsons Mdm LeDoux and Miss Dennhardt. Monday 21. Wire Connor that Fraga wishes him to come to Rio for conference. Another | soldier is dead but Fraga doubts if it is yellow | Abe net ow os _ 66 fever. ye went to Recife as planned - From Muench's station journal) Received this wire at noon and sailed that night for Recife. Authorized to move to Nurses Home from N.Y. arrangements made with Standard Oil for receipt of SP Funds. In the afternoon Dr. Tomaz and I went to Manguinhos where we received something over five contos which leaves Oswaldo Cruz owing but 3 contos and this an old account which Hydrick refused to collect by going to the treasury. We meet Dr. Magarinhos Torres who has been con- tracted for the medical school in Asuncion. He shows liver of Timbauba case and we get specimens | of liver from the first soldier and of liver and | kidney from the second soldier. lLeter in the : afternoon Dr. Torres calls to say thet liver of i second case is yellow fever. N.Y, notified by ' cable‘also Connor, Newspapers carry news of death ~ of Noguchi at Accra, Gold Coast of yellow fever. | Dr. Aragao reports no new cases gispected. Drs. | Fraga and leFayette not seen because at Sante Cruz. Tuesday 22, Connor received wire in Bghia but ! | iL Wednesday 5-23. Connor wires he is enroute for Loti, hein INES Recife. Suspect case in Parahyba. Dr. Guedes UA frown Reb Zt Pereira elsc hee wire about case. Together we ‘ ‘i Be oe. * go to Dr. lafayette and discuss situation. Dr. | a “ laFayette is willing for same cooperation in . 2} thea Fortafeza as in Natal. Dr. Alberto da Cunha is heading up stegomyia control here. Dr. Fraga sick in bed. == Drs. Decio Perreiras and A, Andrade come to office to rflk over Rio malaria situation and we agree on contract basis for 1928. Quarterly report for lst quarter mailed. Government £.e. lower house of Congress passes motion lamenting loss of Noguchi. Dr. Souza Pinto reports trypanosoma in blood of child st Santa Cruz. Thursday May 24. Take citrate tubes to Dr. Aragao at Menguinhos. Consult Dr. Fraga and tell him that Russell has authorized measures in Rio if | request comes from governmen raga is doubtful about diagnosis. The available data on these two cases is now as fallows:Possideon Nino, Pernambuco in Rio five months reported to hospital ill on March 14th - died March 15th. History of previous illness sinee January with bloody stools continuing in spite of, emetine and bismuth. He became ill at the quartey at Campinho. History not very definite. At autopsy 500 ce of urine was found in the bladder, Only liver sections 67 were taken for diagnosis - these were diagnosed | positive by Drs. Torres and Rocha Lima on 19th. : Pedro Lopes, Alagoas, in Rio one year, entered hospital militar for Rx for scabies on May 4th or 5th, leaving on the 16th for Santa Cruz, 40 or 50 M, but in Federal District. Reentered hospitel with high fever on May 18th. Died on May 20th. Symptoms suspicious of yellow fever. Anuria reported. Bladder empty at autopsy. Dr. Fraga saw apyopsy and did not believe case to be y.f. Liver red and solid. Peryassu cut liver at autopsy and was not convinced of y.f. Liver diagnosed positive by Drs. Torres, Oswaldo Cruz and Bomfim (militar) but kidney is not typical of yellow fever. Discussion. 1. These two soldiers are both from northern states where yellow fever has in the past been endemic. 2. They are from different branches of the service and no possible point of contact such as sleeping in the same barracks has been es- tablished. 3. P.N. did not suffer from anuria and 500 ec of urine were reported at autopsy. 4. P.L. had anuria but the kidney is not that of y.f. (Rocha Lima stresses kidney lesions and BW Crowell considered them more important than those of the liver. 6. Both cases must have been infected in the federal district. This means that one or. more previous cases must have occurred. P.L. could only have been infected in the military hospital. No other cases have occurred in the hospital nor do the records reveal suspect cases. 6. Analysis of recent mortality records shows no increase which might be attributed to an undiagnosed epidemic. The epidemiology of these cases does not clearly fit the picture of yellow fever. May 25. No :-new cases have developed. One suspect case proved to be lobar pneumonia confirmed by autopsy. Dr. Connor notifies that Smith goes to Fortafesa. Muench to Parehyba. Reports that Smith believes that case in Parahyba was positive. Bases belief on microscopic appearances at time of autopsy.” Visit by Dr. Guedes Pereira. Saturday 26. Visit nurses home with Dr. Agges who is to make estimate of cost of changes wanted. Dr. Mettos shows room available for deposit of | eect pe nee TN RN 68 heavy objects. Dr. Aggeo states that military | hospital will again be fumigated. "A Menha" carries scare story of 60? cases | of yellow fever is Rio. Dr. Fraga reports nothing new. In considering the Sergipe and other northern } cases, it would appear that the difficulty of } recognition came from the small percent of foreigners | in the region and an underestimation of the previous endemicity of the disease. It is quite possible that these two factors have been respon- sible for giving an epidemiology different from that of other fields with which Dr. Connor was familiar. May 27. Home all day except to Post office in PM with Mrs. Muench. Monday May 28. No new developments Rio. Wire Connor to come to Rio at request of Dr. Fraga. Tuesday May 29. Dr. Guedes Pereira lunches with me at 125 Bolivar. Dr. Guedes is director of P.R. in state of Parahyba, Still no new develop= ments in Rio, Suspect case in German at Aracaju \ now in 5th day reported to Dr. Fraga by the)" maritime service. Dr. Fraga has ordered Arges% to MaKe Gir transformations at new office in Nurses Residence. See “Aurora” with Dr. Jansen de Mello and Suse. Play poor. Wednesday May 30. Meet Miss Bertha Lutz, Feminista. Connor to leave Recife for Rio tomorrow. Wire to R.J.S. - Gov. Lemartine and C. Dantas to lunch. Thur. May 31. Authorize work at Nurses Home ; done by Argeu/ \ we Dr. Lessa’ tells me of suspect yf case in yo Portuguese who became i111 Monday, May 28 Dr. | Alberto Cunha confirms and says case is now at Sao Sebastiao Hospital. Dr. Cunha says case is from Praca Republica but that patient slept in Rua Sao Pedro. Dr. Cunha considers clinically | yf. Later: Visited Sao Sebastiao with Dr. A de | Cunha. Surely a beautiful location for an isola-— tion hospital. Patient, Jose TeiKeira, by name, 19 years of age, Portuguese worked“in candy factory in Praca da Republica. After he became ill he went to sleep (one night_ at 257 Sao Pedro St. Had not newspaper articles appeared recently calling attention to possibility of yf in Rio the doctor who notified this case would not have considered it yf.but an acute severe case of grippe according to his . own statements When he saw the patient he was semi delirious, + i it 2 wi Teg PTAs IH Syesuand continuously mumbling 69 ae Dr. da Cunha says t6 facial expression is charac-— teristic. Examination was by electric light and icterus could not be well observed. Fever reported as 389 axillary. Respiration very rapid and not too deep. Pillow and sheet soiled with some black clotted material and with stains of red blood. Eyes did not appear greatly congested. Teeth in poor condition and gums very congested but no hemorrhage on pressure. Dr. da Cunha examined lungs very superficially and insisted they are clear. Dr. da Cunha demonstrates ‘the marked sensitiveness of the stomach region. Examination of urine (catheterized) wes recorded es "alb. tracos accentusdos." In conclusion Dr. de Cunha insists this case presents the typical signs of yf. The similerity however of this patient to certain pstients seen during the flu epidemic of 1918 is marked. Dr. Henrique Aragao had seen this case and drawn blood before we arrived. I noted, in addition to the site of venepuncture, certain derk black deep subcutaneous spots over the region of both biceps. Could these be deep hemorrhages as found in yf? June 1, 1928. Yesterday Dr. Washington Iuiz went | home after only a week in the Casa da Saude, Pedro Ernesto. Again we can use the Avenida Mem da Sa. A few days ago I spoke to one of the policemen who prevented traffic from approaching thelpspital. "Boa tarde" "Boa tarde" “How much longer must we go the back streets which are poorly paved?" "They say the Presidente will go home Saturday." “Very well. But you know when I had my appendix taken out, no streets were blocked off nor soldiers stationed to maintain silence in the neighborhood! How do you explain the difference?" "Mas o dontor operou - se aqui em Rio de Janeiro?" "No in Baltimore." "Ah, that explains it." And he gave me to understand that were I to be operated here the whole city would be closed! Such delightful technique! Today Dr. Seidelof Sao Sebastiao told Dr. Tomaz that case of yesterday (Jose Teixeira) hed died with diagnosis of "hepato nephritis." This made us feel good for a while as Dr. Seidel also suggested "grippe." However I went out to Manguinhos and saw the iver and talked with Dr. Aragao. There is no doubt but that this case is yf. Blood was taken and has been injected into one Macacus rhesus and one Brazilian monkey. The microscopic examination made hurriedly showed cylindrical casts (calcareous) in the kidney. The liver could not be satisfactorily diagnosed To \ at 2. 8S because of previous lesions. : Together with Dr. Aragao I went to see another suspect case at Sao Sebastiao, viz. Alfredo P, Reis who is a Portuguese and who became ill Monday May 28 the same day as, Jose Teifeira. gy This case is from the Rua B Mad de Sao Felix 76 ORAKAL Y and was picked up by Dr. Lefsa. He is subicteric, hag vomited 811 night, black vomit, has only 37° temperature and is able to carry on a conver- sation but does not talk freely. Detailed history not obtainable. Blood taken by Dr. Arayao for me. Bloods from both cases put in ice ‘at 6:30 PM in thermos bottle. Dr. Lessa makes positive A diagnosis on this case. Impossible to see Fraga but call him late at night. He reports conference with President end Minister and says he has been given carte blanche as far as yf is concerned. I suggest possibility of Connor 7% subordinste personnel to which he agrees and insists that as many good subordinate employees as possible should come. The following wires are sent: "Rockfound NY. Two cases Araca jx Stop. Two civilian cases Rio One agtopsy positive. Monkey injected. Government underteking control. Soper." "Rockfound Bahia If possible Connor should bring trained guarda chefes with him." Dr. Lessa Reports other suspicious hgitories such as Portuguese husband and wife who died last Sunday May 27 after 7 days illness. Alfredo Reis (entered 8:30 PM May 31 - died 4:30 AM June 2) wdled into hospital because motor did not come rapidly. Anuria practically complete. 20 ce in 24 hrs and 20 cc in bladder. Albumina +++++, This case never appeared ill but a few hours before death began to show signs of lowered arterial pression. Autopsy showed typical yf and stomach and intestines full of blood. June 1, Conference with Mrs. Parsons on yf situation. Mrs. Dswson and Mrs. Muench to dinner. Fraga has conference with President and is given "carta branca" in control. Credit of 2000 contos opened in Tribunal das Contos. June 2. AM in office. PM visit Sao Sebastiso end take two tubes of blood from Candido Fernandes who became ill on Mey 30. Dr. Fraga says all guardas and servants are taken from other Services and control is starting rapidly. British consul has been é vised not to permit personnel of HM.S."Goute11is" now in port to sleep ashore. Dr. Warner comes to office and I explein situation 71 as is to him. He says that the child of Commander Wilson had something which mayhave been yf. Dr. Fraga asks me to investigate and report. Sat. PM. Two tubes blood from Candido Fernandes, Rua Barao Sao Felix 198 Portuguese, 27 took sick on May 30 with headache and fever. Has vomited and has heavy albumin in urine. Marked icterus. Taken by me. Dr. Aragao took blood of Ant. Barb. da Silva case for me, This case probably grippe is called Antonio Barbosa da Silva (my tube marked Guiffarees) Portuguese 22, Rua Barao de S, Felix 218. June 3 Sunday. Go to Manguinhos with Dr. H. Aragao. Special screened sections are being completed for experiments'with double screens. Only one monkey has been inoculated so far viz from Jose Teixeira. Inoculation made June 1 from blood drawn May 31, patient became ill on May 28. Temp. at midday June 3 39°C which is about 5 or 6 above normal, Visit Sao Sebastiao and find Antonio Barbosa apparently with a simple grippe. Cindido Fern- andes appears sicker than he did yesterday. Albumin very heavy but Candido urinated 700 cc which is hopeful. Had black vomit during the night and today is yellower than he was yesterday. The upper floor has been screened and is being fitted up with 25 beds. Patients were transferred to this section. Dr. lintz and two or three other MD's were present. Cadaver of suspect case arrives and proves to have been pneumonia, Dr. Fialho says. Willson Russell 9 years old. Back from ope troP Apr. 30. Child became ill about May 20. at & PM and 1 AM high fever 104°C aoa, | Enema and cold bath. Fever down to 103 but back to 104 during morning. In the evening back to normal. Vomited during day illness and also at end of 36 hours after temp hed been normal for 12 hours. Mrs. Willson described as "coffee grounds." Has not been to school nor to other side of tunnel since April 30. Candido d Almeida, 16, Brasiliera, died on May 14 after taking sick on May 9 (Palmyrao friend on hillside) Not yf symptoms. Diagnosis Typhoid with sudden cardiac collapse, Monday June 4. Make arrangements to supply DNSP 100 lamps and probably will give 100 more if Connor does not need. Dr. Fraga insists that Alfandega can be arranged. and authorized order of large amount of supplies. I offer services of Dr. Tomaz Alves if necessary but Dr. Fraga 72 says he does not need. Visit Manguinhos and learn monkey's temp. is back to normal. To Sao Sebastiao and get blood (3 tubes) from Antonio de Oliveira Portuguese, 47 years of age, Travessa das Partilhas 68 who became il] yesterday June 3. Symptoms very light and may well indicate something other than yf. However, he comes from the same street where the couple died May 27. Headache, slight vomiting and fever. Manoel Pereira de Amaral, 28, Port. entered Sunday June 3. Became ill on May 29. Blood not taken. This is typical case. (Rua Barao de S. Felix 48) Candido Fernandes continues to urinate well Prognosis good. Antonio Barbosa (Guimaraes) appears to have grippe. First female case arrived today. Blood not taken as patient is on 6th day of illness. Nina Maria de Conceicao from Visconde de Nichteroy #37. Negress. Abluminuria +. Diagnosis not made, History indefinite. D. Hirageo returns to Manguinhos. Call on Ambassador Morgan and give him details of situation. Dr. Samuel Iichoa calis enroute to Europe. v June 5, Dr. Connor arrives on "Staimbe" at abont 8:30 AM. Newspapers in North have reported 70 cases in Rio. Connor is now ready to. consider the entire yf zone of Brazil as infected or infectible, from Santos to Manaos and from coast to_ Andes. Brings tissues of Parahyba case, 53 years of age, who worked two days ill and died on fourth day. Liver reported by Dr. Aggep° Magalhoes of Recife as not Rocha Lima picture but only excessive hemorrhage. Admits that Murchison was probably yf and that Bahia will probably have cases in next two months. Does not believe that yf in Rio is limited to present discovered focus. Suggests possibility of other than Aedes carrying or other species of Aedes, possibility of animal reservoir, possibility of repeated infections in the same individual and also the possibility of virus becoming attaquated to indigenous population but not to foreign stocks the possibility of Rio being a permanent endemic center and the impossibility of Rtonever having cases in past 20 years. We call on Frega and pertially discuss the situation and agree to present ideas in writing. Connor would like to have Rio and make yf in Brazil one unified project. Request Dr. Warner to keep tab on the Wilson menage and to let me know about Elizabeth Babcock. 73 Connor and I visit Manguinhos and find monkey with normal temperature. Dr. Aragao hes ordered one dozen monkeys from Hamburg on my authorization. We go to Sao Sebastiao and find that Nina Meria de Conceicao had pneumonia and not yf. Two other womam are in hospital as suspects. Hospital notes June 5. Manuel Goncalves Braziliero 28 Rua dos Cajuerios 12 took sick June 4th 2 AM, Awakened by hesdache, fever, has not vomited. Connor considers very suspicious because of hour of omset. Two tubes of blood taken. Candido Fernandes better also Manoel Pergira. Francasco Curte Italiano Albumint+t++, Became 411 June 7 AM June 1. (June 7th this case considered pypical by_ Dra Connor. 20 cc whole blood 10 cc serum seal in ampules. For Africa on Curtg$Candido Fernandes and Manoel Pereira, Probably also worth while to get serum for treatmant purposes from these men. } June 6, Blood from Candido Fernandes Manoel Goncalves, and Antonio Oliveira sent to NY. to- gether with tissues Jose Teixura and Alfredo Reis. on W. World. Anna Jose da Silva, Portuguesa 27 Trav das Partilhas #80 c/1. Took sick at 5 AM June 5th. Fever Back ache. Blood taken at 5 PM June 6. June 7. Joao Bittar, Syrian, 15 years works for tailor, Entered hospital 10 AM June 7. Blood taken 5 PM, Rua Itspiru 49, casa 6 9 years ibn Brasil, Took sick June 4 at 10 PM. Hed contack Thursday May 31 with tailor shop in Rua Baron Seo Felix. Melgha today June 7 subicteric sclerae. Declared positive by Dr. MEC, Two tubes blood taken. — June 8. Maria Jose da Conceicao Rua Itapirn 49 Two days sick. Breathes like pneumonia? Blood taken. ILives next door to Joao Bittar. June 9 looks like pneumonia. June 10 Gives history of vomiting "red" and complains of gastric pain. June 11 is pregnant, etc. June 10. Six new cases have come to hospital from the following addresses yesterday and today. 9th. Joao Ventura, Rua Due Maris (Esticao Coqueios) Sth. Joaquim da Silva, 23 yrs., Rua da Costa, 86, Sot., Port. 10th. Jranklin Sergio Ferreira, Deque da Caixias, #30, Ville , hg hw be AEE VW Ga Ked pe (hee Liao UT Oh bn (LA be | OF Bt at ah Th June 6, Dr. Connor and I visit Dr. Fraga but find him giving attention to many other metters especially newspaper men and so we leave to go to Manguinhos. Cowbereact. June 6. Visit’Dr. Frage and have long and complete on y.f. situation. Dr. Fraga says that once the present crisis is past he himself will gotto north and look over yf situation and will dedicate himself during next 2¢ years exclusively to the eradication of yf. Dr. Connor agrees to submit memorandum in writing. |, \ \ Dr. Guedes Pereira comes to office with the idea \\\ \\ that Rio infected north. There can be no doubt of the presence of yf in Rio for some time. June 7. Conference with leFayette da Fraitas. He says yf must have been here some time as_no primary cases have ever been traced. Dr. MEC explains need for unified programme for all... Brasil]. Memorandum prepared for Dr. Fraga but Fraga not visited. Syrian, Joao Bittar, from Rue Itapicu isolated today. First civilian case recorded outside of known infected zone and his contact has been established through visit to tailor shop in Rua Barao de Sao Felix én May 31 and June 2 during daytime. Became il] 10 PM June 4. Mrs. Sheppard and Allen to dinner. Bow€family ‘Vv go to Sao Paulo tomorrow, ~ June 8. Conference with Dr. Fraga and present- | #~ '+—~ tf Malle iation of Dr. Connor's memorandum to Dr. Fraga teen asks for Tomaz June 9. Call on Mr. Dawson with Connor and see Roche Lima. Dr. Tomaz goes to work in danger zone because survey by Fraga showed larvae after area had been covered. Tomaz says Fraga also asked us to supply him with car. Connor Lobe and Rocha Lima and I go to Sao Sebastie.e Find new cases at hospital but not new enough to draw Grrollare blood. Talk with Dr. Lessa who asks certain ; information in regard to past cases. Dr , asks if R.F. would take over part of city. Dr. Connor and I both tell him we think it not advisable ‘to begin any part way Measures. Cable . \ arrives ‘snnouneing sailing of Bauer and nd Devis and | { 50 monkeys. Dinner with Connor at Copacabana Hotel where fortunes are told. Dr. Tomaz's first day at work results in request for auto for him. Mrs. Parsons promises Ford for Dr. Alves. ’ \ June 10, Sunday AM conference with Dr. Connor. I learn that he was displeased that Fraga ~~ \ beet ey pe ess jyould come into Bio if, RAS: a f 75 mi (0 1494, have been unduly independent ect ob oP A Bert However, I believe that Fr. should have bee informed at the time as it “then gave him an oppor- tunity to choose his course without embarassment. The following is a copy of notes ‘dictated by —_ Conwer Connor as our proper course of action: n on being asked to take over the work. If and when asked communicate with Connor and let DNSP continue until the arrival of Connor which will require ten days. Connor will continue districts and guardas and oilers as at present 320 viz 320 men. No isolation of patients and no be fumigation to be~dorie” ‘by "1 us. So ame te PANE ERR IPN AN et a hem MR AEH Get maps of city with Peryassu's districts marked. Encourage use of our forms. Encourage \ investigation of Matto Grosso, Goyaz, Santos, \ Mines aha Espirito Santo. Include anticulex measures in discussion with Fraga. ” Connor's idea of organization: brine - Seecao de Febre Amarella reporting directly to him with representative of Board in immediate charge with right to employ discharge and regulate the number and salaries of all employees. Funds may be advanced by the board and the Departments , pro-rata share later collected. TPrucking trans- ; portation and customs privileges/campaign to be { developed on a three year basis. “Nominal salaries for our medical directors permits of reduced passenger rates on foreign boats. Connor estimates that 250 contos per month should carry the whole [| programme which would mean 125 for the govt on a 50-50 basis. Davis-Bauer laboratory - must cooperate with Hoty A DMI Brazilians and is pert of Connor organization. hould remain one or two weeks here to see local © situation and talk to Aragao. Get Davis and Bauer programme in writing. Davis and Bauer probably= go to Recife after one or two weeks in Rio going direct with monkeys and material. Best on Costeira boat which stops in Bshia and Recife only. This gives one day in Bahia, Should leave ]5 monkeys with Aragao and 5 with AraYjo in Bahia. ™ Get typed copy of Dr. Aragao programme if possible. Get his ideas of programme for Davis and Bauer and akk permission to Davis and Bauer to come and see him frequently during stay in Rio. Present Davis and pYauer to Rocha Lima and \ maintaia contact. Dr, W on goes to Bahia immediately on arrival, Sat June 16h. Soper Connor believes our entry here will be 76 about Sept of latter part of August (ty trip £6 south should be over by middle of August.) Muench should arrive Parahyba June 15 and Rio July 15. Connor plans to return tg USA early in Nov. but will come to Rio when I return from the Argentine. Information for weekend cable to NY will be wired in each Friday. Biao will deal directly with this office. Connor believes organization can be made ‘ largely self supporting except for sdministrative | C charges through fines and collecting done. d \ é Idea to be presented to Graga if considered ey- visable. Requires official support. Estimate of rotating funds Bahia 30000,000 Sergipe 7000,000 Alagoas material at 4000 to dollar Pernambuco increased ss per wire. Parahyba 5000,000 Natal as is Fortaleza wait for telegram. Requisitions every three months trying to eliminate emergency requisitions. Requisitions can come direct with right to cut if demands are excessive referring to Connor for decision. Same in regard to exceptional material. Burke due for vacation in 1929. End of Connors notes. Connor sails on Andes Mrs. Allen and Mrs. Sheppard sail on Voltaire. Three bloods including Joao Bittar on Voltaire . f) with Purser. Advise mission personnel in Saude (i> sgh, feewres $Y . district to leave if possible. If not possible to take all precautions. 5 cases entered today as suspects including one from Sao Christobal and one from Villa Militar (Rua Duque de Caixias.) Meet Dr. Amaury de Medeiros who is going to talk to Congress ahout yf. Arrange to talk to him tomorrow. June 11. Conference with Dr. Amaury to Medeiros expleining importance of African work and krgeness <3- of problem in Brazil. Service as unit. Dr. Warner calls. Dr. Peryassu calls and I cede 18 lamps leaving fla hire pork Meow 40 in stock. yor gt Find Dr, Fraga rather impressed with 5 cases of Sunday after two days of comparative freedom. He says that he himself believes only in anti- larval measures but that because of question of “morale” he must go on with fumigation and 77 and isolation. Fraga says he has refused to take More men off the other services to increase the “expurgo" group; that the newspapers are making a big fuss but that the government is behind him absolutely. Peryassu says that many physicians are being used in the service of "vigilancia," that he is a voice crying in the wilderness and that Fraga even suggested that he should strain water having larvae. Peryassu insists that only results obtained will be these obtained by his section. Fraga agrees to get Davis monkey and cases right through the customs. agree call Dr. Fraga's attention to our joy over the Parahyba case being diagnosed liver abscess as this clears our service fr the present. Visit Manguinhos and Sao Sebastiao as I have everyday since June Istrsad 3 suspects have entered of which two are positive. June 12. Dr. Burke wires of German nun at Sao Christovao, Alagoas, sick five deys with black vomit, icterus and albumimina. Dr. Fra received wire of suspect case in Bahia Giasce1mann?) who had not been out of city. Two medicos have been suspended for 30 days because of appearance of old cases i.e. more than 3 days in zone under observation. Dr. Tomaz is hard at work with ; car 689. Purchase Soythey's Historyof Brazil. — 2st, - buo Lo To Manguinhos - nothing new. Monkeys ok. Dr. Nowy Lote, Aragao has gotten promise of four more monkeys from Sao Paulo. Three suspect cases in Sao Sebastiao. June 13. Five tubes placed in cold storage at -2°C. Examination of one tube left June 9 at -12°C. showed no breakage. Three tubes Olivio Ant. da Silva, Novello Miguel and Jacob Kaufmann and convalescent serum from Francisco Curte sent to NY care of Purserjon Monargo. Called on Dr. Fraga. Nothing new. Mrs. Parsons says that the report is going round that Fraga said he would either control this outbreak of yellow fever — or commit suicide. Tell Argeu not to do anything to nurses home. New focus today in Rua dos Invalidos, also report that case was at Guanabara Casa da Saude. Two soldiers reported from Nichteroy. Dr. Chagas returned yesterday bringin African virus which he received Aon James in ‘london. Fraga not greatly pleased with Chagas! interviews in papers. To Manguinhos and Sao Sebastiao in afternoon, June 14. Wild rumors are heard that Bahia is full of YF and Santos has ever so many cases 78 In contrast to this Dr. Connor wires that the | single suspect in Bahia is probably positive. The case at Sao Christovao died. Dr. Fraga says that Dr. Chagas is to see him today about programme of studies for Oswaldo Cruz, Dr. Chagas insisting that Manguinhos must get in on the situation. Fraga is I believe disgusted with , Chagas and his attitude. Confer with Dr. Amadepf Masse) Fialho on the question of pathology. He is OA at anxious that the DNSP should have a hand in on the research side. I tell Fraga that I did not approve of statement that the C.R. had annvanced yellow fever extinct in Brazil. Fraga insists ~ that what he had said was that the CR had not found any cases for so long in the north that no one living could have suspected the possibility of Rio becoming infected at the time it was. He says that Rio must have been infected about 4 why the time the first suspect case in Estancia —o aceurred. Confer with Dr. Aragao who has now Aerican virus secured from Marchoux (monkey tissues May 22) in Paris, and four more Macacus rhesus from Sao Paulo. Aragao says Chagas plans on>opening the Oswaldo Cruz Hospital and making complete studies on yf from all possible standpoints. Two casea ave reported at Sao Sebastiao but Dr. Aragao says they sre not inviting. I therefore leave SS off my list today. The papers report two new suspect cases in Nichteroy, soldiers. Called on Ambassador Morgan and found the Embassy thoroughly "Flitted." As Dr, Connor suggested I outlined the situation of yf past an present and also our relationship to the programme. Mr. Morgan seems to feel that_un-_ officially he could not let the govt. know our attitude toward future control but that if affairs come to such a pess that I feel it necessary to submit a written memorandum, he will be glad to see that it gets directly in the Presidents hands. Personally I do not believe we should deal through diplomatic channels but since yf is Dr. Connor's responsibility I shell let him bes agate ye a m J rphonlhg by wae A Ady ABS decide the procedure. Interview appears in Globo with an Hygienista Norte Americano who YF claims methods of Oswaldo Cruz and_@se-Americanos show no essential differences. June 15. Dr. D.B. Wilson and family arrive. fi Dine at 124 Bol. with Mrsv Parsons and Mrs. ve Muench, Visit Manguinhos and Sao Sebastiao with Dr. Wilson, Monkeys have arrived from Sao Paulo and work is beginning with African as well as Brazilian virus. Only very mild or very advanced cases to show Wilson. All Manguinhos is taking up problem of yellow fever from all stand points, 719 blood chemistry, metabolism, blood counts, etc. Some talk also of takingpases to 0.C. hospital for study. Dr. Fraga goes to Nichteroy where there have been four cases among soldiers. June 16, News arrives that Davis is bringing 5 family, Visit Dr. Fraga who has seen interview. wo with Journal in which reporter is told to seek | \ 7) information from DNSP regarding yf. situation {n Rio and North Brazil and who seems ‘very. ‘ pleased with our stand on this question. Furnish Ww cia Eee ving all cases of yf in north so far this year, Wilsnn and family embark Itaquige for Bahia. To Sao Sebastiao with JS and Mdme LeDoux and find a number of cases not previously seen. )Sraw blood from five cases less than seventy two hours. Dinner and bridge with C,pt and Mrs. Babcock. June 17. Sunday. Dr. Renato Studart lunches with us at 125 Bolivar. Visit Sao Sebastiao in afternoon and find one new case less than 24 hrs. and very suspicious. June 18. Dr, Arey jo, Behia, reports Francisco Rubio, Aracaju, (Uruguayan) positive, Jose Bezerra de Mello doubtful and Sister Carusa de Sao Christovao not examined. Connor advises of suspect case Sao Felipe (across bay from Sao S Malvador) and considers suspect in Bahia es positive (Hedy Zollinger, first reported June 9 To S.S. and Manguinhos. Report situation in North to Fraga. Apsit Dr. Tomaz’ zone and find old Ser$phim Visite’, one of my guarda chefes from %3-net 36 Alagoas and Pernadbuco working with him, Ten Buco qoQuezo peu cases todey - one family of three. Dr. P Late ragao tells of one case becoming IT] and remain- ff--pe-—« ing for more’than an hour in a cinema of the poover section where 500 reis admission only is charged and where some go to sleep finding it cheaper than a bed. The failure to find whole families attacked previously may indicate that the infection was occurring largely in points of reunion such as movies, work shops restanyants, etc. Dr. Aragao very hopeful of monkey inoculation for first time. Has monkey with high temperature inoculated from 4 One case sent to Manguinhos for study. June 19, Dr. Ame ty’ de Medeiros comes to inquire about existence of statement of CE to effect that | yf had been exterminsted from Brasil. I give 80 him the details of the conference of Dr. Fraga, Barros Berretto, Connor, | Burke and Soper in Bahia.Jan 19 and also annuel report of Connor's In both of which the programme was outlined of continuing the services in Bahia, Recife, Natal and Parahyba until July at which time a full - survey of the situation would. be. “ade ‘and a programme resolved upon in another ennference with Dr, Fraga in Rio, At this “conference Dr. Connor said that at all events the control of Bahia would be continued until Jan 1, 1929. Dr. aoe says that Connor said in conversation with Fraga that there was no danger of Rio becoming infected, 1 replied to this that no one ignorant of the number of stegs now could believe in the possibility of the infection of Rio after a period of 20 years. That such a statement of Connors must have been based on past experience of Rio itself during periods when Bahia was known to have been infected. Notify Dr.).Barros Barretto of Francisco Rubio of Aracaju as positive case and Jose Bezerra de Mello doubtful. At 2:30 PM Dr. H Aragao called up to say that WHA at Vitus tn monkey #8 injected wih blood from Jacob Mguffmann mvt ade and Novello Miguel had collapsed and was to die. Lh Dr. Rocha Lima called and went to Manguinhos with me. Autopsy revealed liver yellow and fatty and hurried microscopic sections were examined j Dr. Torres and called positiveand very similar to those of monkey killed with African virus, the liver of which Dr. Chagas brought from Paris last week. Russell and Connor notified by wire. Liver to be Frozen and also tissues in forms were secured. (Dr. Chagas asked how the CR explein the entrance of yf into Rio. ‘Titell the necessary information on ‘which ‘to base an explanation. He seemed quite surprised to learn that the CR still has service in the North of Brazilt) Iater in the evening Dr. HA says Macacus cynomalogus probably from Japan is expected to die during the night. June 20. Called 0.C.I at 8:30 AM and find - Aragao asleep. He lay down at 5 AM, At 11 AM 2 anjsb © start to SS, Find one new suspect case. (Positive being Provaly,