mam NY

For additional notes on period 1
January 1-26, see pages 122-125 °

Jenuary 1,1929. at beginning of Journal.

Dr. Henrique Aragao mentions the possibility of male mosquito infection through
feeding on contaminated honey. If this works out it should be possible to presefve
the virus in mosquitoes without danger to laboratory workers.

January 2. Dr. HRocha-Lima calls at office to discuss various matters. I meet
Dr. Aleides Lintz at the DNSP and learn that our contract for 1929 with the state of
Rio is all ready to be signed and that our contract for 1928 was passed as a law of
the land by the 1828 legislature. Dre: Lintz says there Rkasbeen no yellow fever in

me

the state of Rio for more than four months. Although he does not say so in so many
jee

 

words it is quite clear that he wishes to implicate that his service in the state
has been far superior to that of the DNSP in the Federal District. It is indeed
ee -

pret

 

difficult to understand the optimism existing regarding yellow fever in a place
which suffered so much in the past fran the disease. Dr. Lintz for example is un-
doubtedly ignorant of the monthly distribution of deaths fram yellow fever in the
period previous to the work of Oswaldo Cruz. Also he does not properly appreciate
the importance of today# case reported fran Anchieta, a suburb of Rio in the Federal
District in direct contact with numerous populous centers of population of the
state of Rio. | |
Jenuary 3. Dr. Muench, Br. Aragao end I go to Braz de Pinna and meet Drs, Ba
Fayate Freitas and Dr. Rodrigues. Dr. Fréitas shows us a child who undoubtedly
has been having a mild attack of yellow fever and a woman who is ill but with such
vague symptans that no thought of yellow fever would be entertained were it not for
the cases already confirmed for the neighborhood. Dr. Freitas says that he believes
that a large number of cases of yellow fever of an undiagnosable type is occurring
in the native Brazilian poptlation. |

Dr. Fraga state that the contract is almost ready to be signed for the yellow
fever service and that the only modifications to be made are in regard to postal
and telegraphio franks. The copy will be ready tanorrow. Dr. Fraga marks our trip
north for the Andes leaving Rio on the 20th of January, in spite of the recent

eases of yellow fever in Rio. Dre Fraga insists that a signed contract be drewn up

oe ON a

Ne tN ON ee ann

between the government = the Foundation as the Minister of the 1 Interior Gonetders

we, ee ON eee ON ee ee

ee

such contract essential to guarantee payments beyond the term of the present

ON Ne te es ot ent ee

one

 

BN ra

government.
HD+
MD~

Bott ~

26
Jenuary 4th.

Dr. Aragao suggests that a large amount of serum be secured from the Sara Rivas
case in Bahia to determine whether mild cases give the same protection
to monkeys that severe ones do.

I cable New York asking for authority to sign contract for yf service. I get

hold of Manoel Dantas and Henrique Bias of Braz de Pinna as they sre leaving HSS

end take them to OC where HA bleeds them. Manoel Dantas is a black boy from Bahia
who had a febrile attack with congestion of the eyes two days after being waccinated.
Henrique Dias is the uncle and roommate of the Portuguese who died from yf at HSS
removed from Braz de Pinna a couple of days after Xmas.

Dr. Fraga says contract is not ready yet. He enquires about the possibility of fellow-
ships this year. I explain that we are now on a budget and that the most that can
possibly be arranged will be one fellowship and that even that one depends on the
failure of candidates already under consideration to qualify. Dr. Fraga offers his
personal help on our accounts with the Federal Government which have fallen into
Exercicios Findos and suggests that I submit a list of these accounts to him. Our
trip to Recife is still marked for the 20th of this month.

January 5th.
Miguel José Sant’Anna died of yellow fever in Bahia,

January 6th. Sunday.

Dr. Muench and I meet the Andes and get package of Virus of Chicken
Sarcoma from Burt for the 0C in Bello Horizonte and then drive out to HSS.

January 7th.

Dr. HA reports that monkey injected with blood of women in Braz de
Pinna has fever as has also the first transfer from this monkey.

Dr. Raul Magalhaes of Minas is in town. He seems quite optimistic
regarding yellow fever and does not believe that anything his state.

fack soire Mttecnbery tafe dom Wad 1431)

I am informed from confidential sources that a woman from the Rua
Prof, Gabizo died at the Santa Casa with the diagnosis of gastric ulcer but that
autopsy showed characteristic lesions of yellow fever. This case is not being
notified to the health department.

January 8th.

January 9th,
Dr. Mueneh and I spend the forenoon mapping Braz de Pinna. Dr.
Almeida de Mello of Par& is now in charge in Braz, Dr. Rodrigues being occupied
in Paquet&. Dr. Almeida took Dr. Boyd’ course in malariology and talks knowingly
to us about cleaning up ditches to prevet stezomyia bredding.
~~ Monkeys from Braz cases are still running fever.
Today for the first time I meet Dr. Aragao, an uncle of Henrique’,
who is a clinical inspector of suspect cases of yellow fever for the health department,-
He says that two Germans had died in Birbaum& house in Anchieta before Birbaum was
diagnosed and that a man had died in the same house with Mrs. Stael, Rio Comprido,
a few days before she became ill.
Dr. Mauricio de Abreu says that copy of contract was sent to me today.
Cable received from NY authorizing signature of the contract.
Tribunal de Contas approves opening a five thousand conto credit to
pa’ fitty per cent of expenses in the north and six thousand contos for the Fedoral
Seri iets a ee
— The Globo carries a telegram announcing yellow fever in Parg.
Fe

January 10th.

Dr. Muench and I spend forenoon in Braz de Pinna mapping. Dr. Rodrigues
gives me his census list to copy. A girl at 26 Rua Guaporé has fever and is bled
for HA.

ee ON ee

HA reports that monkeys from Manoel Dantas and Carmen still have fever.
He says that monkey injected with mosquito feces shows fever today; monkey bitten
Se
J anuary 10th continued,

By the same mosquito is yet without fever. (If fecal contamination is the rule
the absence of itching in old residents will explain part of their apparent immnity.

Dr. Fraga confirms the news of yellow fever in Par& and adds that a case has
ocourred in Manfos. I assure him that Muench will sail to take charge in Belém on
Saturday the 12th, I finally receive copy of proposed contract. CF says that he
probably cannot go north on the 20th as planned.

HSS has suspect typhoid case from R. Prof. Gabizo 118, If confidential inform-
ation of Jan.8th is correct this case may well be yf.

January llth,
Dr. Peul A. Lewis, of the Rockefeller Institute arrives on the
American Legion. Dr. Lewis is a brother of Dr. Marian Lewks of my class at Rush

and Cook County Hospital. Dr, Lewis sees five cases of yf at HSS,calls of CF and
HA, Vace;nNATED By HA aX MANGU/NAOS.

Januaryl2th.

Dr. Muench sails of Itaquicé for Belém; Dr. Lewis accompanies him
as far as Bahia, I wire Dr. Davis to infect monkeys of Sunday to have material
avaidable for special preparation for New York when Lewis arrives.

Jamuary 13th.
To HSS in PM. Return Dr. Rodrigues his census of Braz de Pinna at his

home in Olaria. Existence of foous of yellow fever on Ihla Paquetaé confirmed.

January 14th,
Wire received from Recife of suspect case there and of illness of Dr.

Crawford.
Dr. HA is informed in detail of the technique used in New York for
drying the yellow fever virus.

Secure information regarding carbon dioxide snow for the Bahia
laboratory.

Dr. Tomaz Alves goes over the proposed yf contract and decides
that Foundation interests are adequately protected, So ~ ~

 

~~

I meet Dr. Chagas accidentally on the road te OC and am surprided
to have him inquire of me about how mich yellow fever exists in Rio. It would appear
that part of the campaign to keep yf out of the papers has consisted in keeping
cases out of the OC Hospital where information is given freely to the press. Dr.CC
says that he will see CF and arrange for more cases in OC. CC reports that the
Brazilian virus is no longer in the laboratory of ocg

Dr. Costa Lima has been working with HA on the feces transmission
of yellow fever. The first experiment showed that transmission may occur either
from the bite or from fecal contamination.

In conference with CP I notify of suspect case in Recife. CF marks our
trip to Recife for the 10th of February. If CF goes north at that time I shall
probably remain in Rio and arrange for Dr. Connor who is expected from Europe to
meet him.

January 15th.
Captain R.A.Warner says that he has been unable since the beginning

of the present outbreak of yellow fever to get the Navy to take any precautions
on its own responsibility in regard to stegomyia breeding control. After discussing
the possibilities, he says he will try to get the Brazilian Navy to install a
laboratory for experimental work on yellow fever.

Wire reports that Crawford is better.
4.
J emery 16th.
To HSS and OC. Inform HA that Beeuwkes also found monkeys dying
of yf without fever and that NCD has had the same experience in Bahia.

January 17th,

Wire to Crawford, Recife, and Burke, Bahia, to imcrease personnel
if necessary.

Learn that the government opened our credit for five thousand contos
yesterday.

January 18th,
and I go to Braz de Pinna and bleed Carmen, Djanira and Gecilia,.
Dr.CF asks for supply of convalescent serum.

Jamuary 19th,
ribunal de Contas approves action of ‘government in opening credit
for cooperative se Cee te
ea

January 20th,
Dr, Andfade calls and submits draft of malaria contract with the

State of Rio providing that the RF take over the administration of the service

end containing certain other disagreeable features, Considering the fact that

only one year ago the service was turned over to the State at their request I
refuse to consider this proposed draft. It seems very difficult for state and other
officials to get the idea that the Foundation is not a business concern and to learn
that after a proposition has been made that it can be accepted or rejected.

January 21st.
Meet Dr. Vilela of Bello Horizonte. He previously worked with Chagas

on Chagas’ Disease and contracted it himself, His heart is I understand in very bad
shape and he finds it necessary to limit his activities closely{ Dr. Vilela says
that Dr. Pimentel, dean of the University of Mjnas Geraes is anxious to get in
touch with the Foundation with regard to the future organization and development
of their project.

Impossible to get rooms for Mrs. Muench in Petropolis. I suggest
Therezppolis and vaccine both of which are refused.

January 22nd.
Carmen (Braz de Pinne) monkey died of generalized tbe.

Lt,Col. TT Behrens of the sireraft survey of Rio called and was
adviged to have his foreign personnel sleep in the uninfected districts of Rio,
. Regis, Lott and Torres fellowships approved, Soe,
) drausvak sdk

January 24th.
Mrs, Parsons is requested to learn details of/Cabral family looking +:-7

toward payment of funds on account of Miss Iracemks death<
To HSS and OC. Dr. Penido reports several cases with vomiting and
‘fever in Braz de Pinna,

January 25th.
Funds transferred for the last payment to the Faculty of Medicine

project in Sao Paulo.

Contract with DNSP d in the presence of Dr. Mauricio de Abreu
and the photoghapher of the Associated Press. bagewncng pomp yi

Mrs, Muench vaccinated.
Loaned Dr. Sinval Lins, of HSS, Klots’article in Delamar Lectures,

?.

January 26th,

Visit HSS and OC{ Leave bloods with HA for drying. At HSS Lins

demonstrates large number of cases to be fiot yellow fever. HA and I discuss

need for further laboratory facilities in the study of yellow fever in Riog HA
says he is going to urge the DNSP to install another laboratory and that the RF
might install one here with largely Brazilian personnel,

Monkey infected with mosquito feces only died today of typical yf.

Attend at night in Nichteroy the presentation of the plans for the
Se

January 26th continued.

a NEW REGIONAL HOSPITAL which is Dr. Lintz’ chief hobby at
. the present time. A thoroughly tiring and uncomfortably hot evening was spent by
all who attended. Lintz says that he has had no cases in the sfate for four months |
and eight daysi!I!t!t! He seems particularly pleased that no further cases have
occurred in Nilopolis. We discuss the possibilities of extensive spread later in

the season particularly after Carnival-I point out to him that with CF denying the
existence of yf in Rio bith he as Chefe of the Prophylaxia Rural of the State of

o end therefore a subordinate of Fraga$ could not advertise the true conditions.
to his people and advise them not to come to the Federal Capital for Carnival. He

‘agrees that this is sol!!lf!
© JORNAL publishes the terms of the yf contract.

January 27th. . '

HM reports the fourth case for Belé

To HSS and find sass Prom Nova Truase6/. Thus the bubble bursts
after four months and nine dayst a

January 28th.

I write to Dr. Burkecthat the increasing of Bpiphanio& albuminuria
regularly during four days looks very suspicious of yf and that cough may have been
due to congestion only. (Epiphanio is NCDS assistant in the laboratory.)

January 29th.
The funds for the yf service in the north were made available under
"eredito extraordinario, decreto 18560 of January 15th,1929.'

The results of pathological examinations reported here at the present
time are somewhat confusing. On investigation I find that Dr. Fialho is in Sao Paulo
and that autopsies are being performed by Drf Bonifacio Costa, who 18 not a patholog—
ist, but who is preserving tissues from all cases for final diagnosis by Fialho.
Fialho was previously offered a good position in Sao Paulo and rumor has it now that
he has gone there to see what can be arranged. It is believed that CF and he have
had a set-to regarding the diagnoses made or disclosed here.

NCD letter to FFR of Jan.l17th repppts incubation period in monkey of

 

 

 

 

fifteen days,
Globo reports HMYinterview in Belém in which he is quoted as saying
that the RF is using the same methods as OC used in the old days with the exception
of those which 0C_ would have abandoned before now were he still alive, Dr. Tomaz”
comment was simply tHE lost a mighty good opportunity to keep quiet.
CFyvSeys that HSS has two diagnoses on some cases;that he receives a
confidential lis om the Hospital eash day whi ometimes quite different from
q prepared for public consumption. CF says that it is necessary for political
reasons to keep the newspapers :nd the public from knowing the true facts in the
case. His Present statement of conditions to me is based_on Dr» Sinval Lins’ fear
that I might pick up _a positive monkey on one of his grippe cases. == ~~~"
NF shows me correspondence from Dr. fateed McClure, transmitted !
throughtdiplomatic channtls from Berlin, in which Kuczinski offers for a consideration
to come to Brazil and demonstrate his methods of etituring the organism of yf.
I tell CF what I have heard regarding previous work of Kuczinski but am forced to
admit that I kmow nothing of his work with yellow fever.
CF and I discuss the crying need for more laboratory work on yf .
in Riof He says that he gave the 0C oi ght contos last year for the purchase of Honkeys
but that he does not care to depend on their laboratory in the future{ Just as he
found it advantageous for the DNSP to install its own pathological laboratory instead
of depending on the laboratory of the OC, he now expents to do the same with yellow
fever but can do nothing until the present rush is over. Fraga says that our lab
should have been here in the first place. _
: sks for vaccine material from our laboratory in Bahia, fort
tre te iG37

 

 

 

Mr, Carl Dietsch takes through material for New York. lin tg > Moye
Loaned Dr/ Mattos “Conf. Africaine” for Dr. Sinval Lins. Mar ©

To HSS and OCI. Secured 88 ampules of vaccine for Capt. RAW,

January 31st.
DR. Juan Barros Barretto called up and asked for permission to quote

NCDS results with flight range of stegomyia.
Feb. 1.
To HSS and find a heavy run of cases.

FebeZ.
Advise Mrs, Muench of the local situation and advise Therezopolis.
Febe drde 4

To Therezopolis for the day. HA happens to be going also and makes
our trip rather pleasant by showing us around. Learn that Mrs. Leuszinger
is hie sisterinlaw.

Correio reports the first case from the city of Sfio Paulo, fran

the section called Alto de Mooca j
I learn from trustworthy sources that there have been at_least 12 - "

 

deaths this year in Anchieta due to yfg that most of these, in fact all but

fwo have been buried with other diagnoses to avoid the displeasure of the

family at being forced to permit autopsies; that compulsory autopsies have

been used to force other diagnoses rather. thaty yellow fever. fo
Nilopolis is flooded so that it is impossible for the guardas to get

about from one house to another, Suruhy is kmown to be infected.

Feb.4th.
Called Dawson and notified him of the availibility of vaccine. To
HSS. See ALBB of Bahia at DNSP/ rn

Feb. 5th, Tian bmg, ds Baris Pav she _
ALBB called at the office and found Uchéa with mes BB interprets —
clause 8 of the new contract to refer to him in Bahia; refuses to recognize
Burke as "full time medico". Believes that monkeys and lab material are to
be imported at expense of RF according to obaeee 16 although this clause . |
specifically mentions only clauses 10 and 11 and not 18. I call attention
to the specific inclusion of the Laboratory in section 17. BB says that he
receives nothing from the CR but that as representative of Dr. Fraga in Bahia
he expects to continue to fiscalize the work of the CReand that his cooper=
ation with the CR has always been of the closest/ To hear him tell it to
me it would appear that he is one of the closest personal friends of both
MEC and AWB. He insists that we need his eooperation and I agree that with~_
out it we had better pull up stakes and leave. I also let him in on the .
secret that the CR has no money with which to pay duties on monkeys or any :
other laboratory material. BB says that he knows that certain people refused |
to gecopt the diagnosis of yf in Estancia even when suo ‘
Mtimade by Rocha-Lime, says that he to onnor that if he did not change
aa to a weekly schedule that he,, BB, would have to take over the service,
is quite apparent that BB belheves that ingthe past he has been in a-posit-
ion to get all the glory from yf control in Bahia with none of the work nor
blame for failure and that he is not at all pleased at seeing his position
changeing to that of passive looker.) I try to tell him that I see noth-

 
 
      

 

ing but the opportuni lot of good hard work for all of us for the }
next three years; that after all this cipated hard is enti =.
ossible Shae t esult may not be what we hope for.

 

HA and I call on CF and discuss the need for more monkeys for the
work in Rio. CF says that S&o Paulo case was a woman who had been isolated
under a mosquito net on the Ilha do Ggvernador but who decided not to re-
main there and tcok the train for S&o Paulo where she didd of yf. CF dis-
cusses the coming Congress of Hygiene in Recife in September and talks about
going to the USA in Ogtober of this yeart!!

Feb. 6th,

Special shipment of immune monkeys arrives from Davis without any
shipping papers.

Wille notifies that German house does not wish to ship animals
because of prevailing cold weather. I authorize the expenditure of funds to
construct weather proéf cages for the animals but insist that they must be
shipped,

CF says that he does not expect to open waccination stations to _
the general public but expects to reserve the availably supply of yf vaccine
for foreigners, especially immigrants and foreigners living in known fooi
of the disease. .

See Rosalvo Martins sent from HSS oc 39° G,
Feb. 6th. continued.

HSS now has many empty beds and is receiving almost
‘no new cases. Did the epidemic suddenly stop last Sunday?

Jimmie Muench answers to sick call. Drs. Machado and
Warner called in.

Feb. 7.

Ha suggests that Davis make early captures of mosquitoes which
have had blood meal in the house before being turned loose.

I ask Davis to send monkey material for the prepar&tion of vaccine.

HSS received two cases yesterday hoth of which died today. Four
cases entered today but all were from other institutions. (Does this mean
that only those cases are being removed to the Hospital which cannot be
kept at home?) Report has it that the situation in Nilopolis is bad.

Feb. 8.

To HSS and DNSP. Complain to Mauricio that DNSP already has its
CC14 but that we have not yet received our good s which were to come fran
the customs on the same day.

JMello insists that his main difficulty at the present time is the
control of breeding in the roof gutters. He plainly needs more sleep than
he has been getting. JM invites me to visit his zone.

Feb.9th.

Dr. Mauricio says that our contract is not registered and that it
will not be possible to begin paying operating expenses on the contract basis
before the month of March, .

HSS has three new cases today. Second case is reported from SPaulo,
Confereuce with CF regarding the chlorination of the Rio de Janeiro water
supply. CF very plainly not interested.

A868 I call on BB at Itajub& Hotel; BB says that the CR is none too
strong in Bahia; that if was He who protected the CR when everyone else
Was against It; thet he is the Secretary of Malth of the State of Bahia;
that the present contract was made without consulting him; that the CR
may proceed to assume all the responsibility for yf including fumigation;
that he will sit by with folded hands and watch the performance; that by
right and by justice nothing regarding yellow fever nor any other disease
should be done in the state without consulting him; that he eould go to the
state covermambh and easily secure three or four thousand contos to elim-
{nate yellow fever from Bahia; that OC did it for Rio and the south of
Brazil during twenty years; that _as a good Brazilian he is interested in
the elimination of yf from _all Brazil but that as an official of the state
of Bahia he is only interested in its elimination from that state; that
Bahia is the chave to the situation for dll Brazil and without work in that
state that all efforts in other parts of Brazil are useless; that he does
not intend to be made an “idbbta" by this contract; that he is the repre-
sentative of the Federal Health Department in the State of Bahia and that
as such he should have a voice in the spending of yellow fever funds sup-
plied by the federal government for work in that state; that he, BB, was
quite surprised that I had written to Burke that he should not have con-
sulted ALBB about spending money for motorcycle and motor launch, although
he admits that he had not felt offended when AWB purchased a new motor car
in January without consulting him. BB says that the CR offended and insult-
ed the entire medical profession of Bahia by sending Hale, a non-medical man
to_ organize and direot the service in Bahia;that one of Hale's men was
Fillet anon te entered a room against the orders of a householder, BB admits
that more than a quarter of a century has passed since the work of Redd's
committee and that in spite of the knowledge made common to the world at t
that time that neither the Brazilians nor the CR have extinguished yf from
Brazil although all other parts of the Americas have apparentxy been cleaned,

but insists that it is not necessary for Brazilians nor the Brazilian zov~
ermentf#to give Stistaction to anyone Tor suoh failure; that it ia entirely
Petr pm personal affair. BB ridicules the suggestion made by MEC last year
e state organize mosquito services in the interior to be fiscalized
by RF employees; if such services could be organized by the state they could
also be fiscalized by the state, BB says that the yf situation in Brazil is

ee,

 

 

 
Feb, 9th. continued.
me is much more difficult than the RF has ever known
br admitted; that he kifows that MEC had plans all made to withdraw from

Brazil last y6arj that he has been accused of recelying money from the
SESE OTe so well last year which acousation he denied

with vehemencel!l! (He seems to forget how long I have been in Rio and may

not_know that the vouchers of the yf Service have been passing through the
i

o office for same timely BB considers AWB's recent proposal to readmit

arrels as very ill advised, However, he pictures the situation in Bahia
as one of sweet contentment all the way round; he loves both Connor and
Burke and they both love him, BB says he purchases sera and vaccines to
the amount of 120 contos per year in Rio which he might well make in Bahia
at a cost of thrity to forty contos but that he has ceded willingly his
new seruminstitute building to the CR for their monkey laboratory.

After the above and much more we part the best of friends! An analysis
of the conference with BB shows a dozen veiled threats,

 

Feb. 10th. of

See Gloyer case with Capt. Warner who suspects yellow fever.
Onset clear out yesterday at noon. High fever and high pulse with no con-
gestion and no vomiting. Clearly not yellow fever.
Feb. llth.

See Glover again. Not yf but report case to CF as suspect. G has
slight albumen “in the afternoon.

Feb. 12th.
See Glover. Not yf although has albumin. Temp 102 pulse 112. Dr.

Thompson Motta sees Glover and agrees is not yf.

Feb. 135th. phe
GYearefully examined by TM=no diagnosis made but yf excluded,
een ge A A Ct

 

£ Lh Anbar

wo 2

Reb.14th. jor en
Make arrangements to pay 20:920$500 against power of attorney of ie
‘General Cabral. Vaccinate Thompsons, Bawsons, Buchanans and Burt. z reel .
Contract has been registered by the Tribunal de Contas. 35 Urabe

Feb,15th, hex : y

a G‘with many casts_and reduced output of urine. Visit from Dr.
S.Uchoa, I learn today t ALBB gave a modified tabella for the P.R. of
Bahia increasing his salary to 4:800$000 per month but not increasing the
salaries of servants and other low salaried helps His argument was that

they were accustomed to living with low salaries but that he was not.
4 oe OO

Feb. 16th.

Glover has fewer casts and more urine today. See three suspect o
cases close to OCI with Dr. HA and Penido. These look very suspicious but
later prove to be malaria.

Dr. CC recommends a Dr. Fontes for work in Bahia at the instance
of Dr. Castello Vianna and asks for the laan of four monkeys from Bahia.

( The above mentioned cases sonsisted of a Portuguese man woman
child who were ill in the same house; the child had been quite ill but was
improved to such an extent that she was up and about;the man was quite ill
and was very congested with high temperature; the woman was complaining of
abdominal pain, vamiting and fever; evidences of black vomit were to be seen
on the floor and her interus was very definite. Dr. Penido made a diagnosis
of yf on the woman and I on the man ‘if it were proven that they did not
have malaria!' When the ambulance arrived they had all fled only to return

two days later with clear cut picture of malaria!) 414 rh fj op
Sap porter

 

i