3.
April 14th, Sunday.
4th 1929,

Quotation from Burke, Bahia, Stetion Journal of March

“Dr. Connor called on Dr. $06 at the Secretaria; he asked me to call

a little later. When I entered Dr. Barreto was greatly excited. He said that when

he was in Rio Dr. Fraga told him that he was to have nothing to do with the yellow
fever service, and now the yellow fever service is asking him to do all the fumig-
ations, to isolate and treat the yellow fever cases and suspects, and to enforce

the statutes regarding mosquito propagation. He said that Dr. Fraga made the state-
ment that he could force Dr. Barreto out of his position, and that he has good reason
to believe that Dr, Fraga will be the first to be separated from his position. He sta
stated that if he is to do fumigations that there should be a federal budget to

cover this phase of the work. This internal strife is very embarrasskng to our
service. It would appear difficult if not futile to try and conduct a yellow fever
service here without the cordial cooperation of the Chefe Prophylaxia Rural, which
office in this state is combined with and under the direction of the Minister of Healtl
for the above mentioned reasons: lst, Enforcement of Statutes; 2nd. Fumigation: 3rd.
Isolation and care of the sick.

"Dr. Connor said he would telegraph Rio stating that Dr. Barreto insisted

upon federal budget to cover fumigation. "

Dr. Andrade admits the first case of yellow fever in his control areaz
viz. Honorio Almeida, of Mesquita. However, as was to have been expected, he insists
that this man wasfinfected in the Rua Clarimundo Mello, 261, where he worked for

five days before onset.

Wire received from NY stating that lavatories ordered will cost six

thousand five hundred dollars and can be supplied only after nine weeks. I consult
CF who authorizes purchase if delivery in Rio can be made before June 15th. Cable ny{

Dr. Fraga finally returned to-day to the question of chlorination of the
Rio water supply, which I had mentioned to him some weeks ago and asked for liter~
ature on the French publication, At the same time he asked for information as to where
the apparatus could be secured for applying chlorine gas. I promised to secure liter-
ature for him as well as catalogs and possibly information as to the local agent of
Wallace and Tiernan, Called Mr. Ellis on the phone this evening and learned that I
was right in believing that his company are local agents for Wallace Tiernan. He
promised to send his sub-manager, Bnr. Vianna around to see me to get the necessary
information before approaching Dr. Fraga.

Called on Dr, Shagas at the Oswaldo Cruz Institute and had a long conference
with him. He believes that the real contributions of the Institute to the study of
yellow fever have been the work of i Torres on Cell Inclusions, of Costa-Lima on
fecal transmission and of Costa Cruz on disappearance of complement. He considers
that all of the work done by HA represents merely a confirmation of work done by the
English and American investigators in Africa. Dr. Chagas is ae interested _ in
finding the germ of yf and himself believes that it is a tiny spirilla, (This belief
is probably due to the recent discovery of Costa Cruz that spirillose in chickens
cause a disappearance of complement in the chicken similar to that produced by yf in
man, I try to point out to Dr. Chagas that these side issues are not the most
important here and ew; thet they are the sort of thing that can be worked out any
place in the world in the future; that the important thing now is to get some
information on the epidemiology of yellow fever; that he does not need a large
crew of scientific men to do this type of work but that HA with adequate subordinate
personnel and plenty of monkeys could adequately run the laboratory work and that
one or two field men should be used to get the necessary material. I doubt if the
real idea ever got agross to him but one can never twll-I was thoroughly convinced
that my remarks to Dr. Fraga some weeks ago on the chlorination of water supplies
had fallen on absolutely deaf ears until he himself brought up the question today.
Dr. Chagas says that they are going to have plenty of monkeys, that they do not have
room for a great extension of the monkey laboratories and that fifty have already been
ordered for this month He further says that once the vaccine bubble appeared to

burst that the DNSP has not been interested in giving money for monke
purchase fifty grams of quinine for Dr. Hackett at last. I trust that

Dré Chagas either never learned or else forgot the details of the last transaction.

I asked and obtained of Dr. Chagas permission to use all of the clinical observations
on yf cases at OCH in making out out epidemiological cards and also permission for
Dr. Kerr to visit cases daily there if he cares so to do.

 
4.

April l@th. continued. ~

Call on Dr. Aragaos he asks if our personnel in Bahia
had made transfers of virus through guinea pigs and then back to monkeys. I said
that if such had been done in our laboratories or not was unknown to me but that
from confidential sourees I understood that it had been done by other workers and
that the work should already be published although I had not received any reprints
of such publication. HA displays a very ingenious arrangement for getting mosquitoes
to evacuate on glass slides; a trianular gage is made of three microscope slided,
fastened together with adhesive tape and with the ends covered with Gauze.

Note in Smith’ station journal that he feels the lack of clinical exper-
lence with yellow fever. It might not be amiss to have the men in the North make
hurried trips to Rio to get familiar with the clinical side of the diease they are
spending so much wenery and money fighting,

Dr. Chagas says that he cannot understand how yellow fever oame to be
He believes that i conducted service should have eliminated the disease very
80 widespread in Rio. ) early WITHOUT the formation of so many secondary foci,
I showed him the general mortality curve of last year and told him that yf was
probably present here some time before being discovered and that multiple foci had
already been established when the first diagnosis was made. He says that he himself
spent long days doing vaccinations against small pox during the 1926 epidemic; that
he took no interest in the confirmtion of cases and permitted the employees of the
department to give information freely to the press. I explained that the mortality hump
of last year has nothing comparable since 1923 with the exception of the small pox
hump of 1926,

April 16th.

Mg{ Vianna calls and I explain to him the reason for Dr. Fraga& present
interest in chlorination. He is given a letter of presentation to Fraga. Dr. Tomaz
says the eopy of 0 Saneamento containing a note on chlorination in Daker will be off
the press today.

Connor wires that Gouveia de Barros reports four suspeots from Recife
negative, ~

Biaowwires that service in Laranjeiras and Riachuelo is being opened
on the 15th of Rpril,

Call on Dr. Fialho again in an attempt to secure the tissues requested
by Dr. Sawyer for Drs. Cowdry and Kitchen. They are promised for day after tomorrow.

I could have gotten them today but Dr. Fialho is sure that his technician by mistake
included tissues from a malaria case, which would be enough to disgrace him should
it be discovered by accident in NEWYORK.

Call on Dr. Rangel to secure the statistical reports. He has made the

curves for last year and he also believes that the mortality fro yellow fever began

to be a serious factor in eperal mortal e Janeiro about April ls

4e28 although no civilian casos were diegnssed Ter Some ohne ot Sia ee aT igh

he does not say so it is clear that he believes that but a small percentage of fatal

cases of yellow fever have been reported since the beginning off the present outbreak.
The Noite carries a paragraph today calling attention to the request of

Dr. Sampaio Vianna, director of the Demographic Service for many years for six months
leave of absence. The Noite says that this action was taken because of his unwilling~

ness to eliminate from the mortal tables of Rio de Janeiro, deaths from yellow
fever coourFing 1m people Foaling cuteide the districts Previously the ousten bes
been for deaths to be registered where they occur without reference to the place of
origin and without reference to the cause of death. The introduction of a special
ruling at this time in regard to deaths o€curring from yellow fever is falsifioation
of the records, the Noite would have one believe.

I met Dr. Souza Aguiar who asks for catalogues with dimensiens for
installations for HSS Cabled New York requesting catalogues.

Inform CF that I have given letter of introduction to Snr. Vianna
who expects to @all this afternoon at fifethirty PM. Dr. Fraga surprised me greatly
by saying that he is going to stir up a lot of opposition but that he is going to
recommend to the government the chlorination of the Rio water supply, the installation
of watermeters which should permit the abolition of oasixas d&gua, and the alteration
of the building code in such a way that future constructions mst be without eave
gutters and providing for the elimination of as large a number as possible of the
gutters already existent. I seize the opportunity to make remarks on the need for
permanent measures@of control and call attention to the fact that methods of travel
have progressed much more rapidly in the past quarter of a century than have the
methods for the control of yellow fever.
ss
eerie et
x

ae

5e

April 16th. continued.
Send Dr. Fraga this month& Saneamento which carries in
Portuguese translation an abstract on the use of chlorination in Dakar,

Send Dr. Hackett ' quite a box ' of quinine consisting
of 100 pills with a Merry Xmas card for 1929.

I find Bré Amarillo Zsconcellos in the DNSP giving to
Dr. Fraga a letterffrom the manager of the Hotel Copacabana stating that the
guardas never failed to examine the hotel completely. It seems that this letter
was caused by the report reaching Dr. Fraga through Dr. Sampaio Vianna that the
guardas never went above the first floor of the hotel. Dr. Fraga had also told
Dr, Amarillo that Br, Beeuwkes had found stegomyia in his room on the fourth floor.
Dr. Amarillo tells me that he is being transferred to the fumigation service. I
talked quite frankly with Dr, Amarillo and made no attempt to cover up anything that
I have said or done in regard to finding stegs in Copacabana. I trust he does not
feel that his transfer has been occasioned by anything that I may have said.

April 17th.
Mrs. Herron, secretary, goes on extended leave (7) today. I spend

all day in office spending much time on Said Annual Report Mr. Cunningham calls
and agrees to take our second April shipment at 17%, the first April shipment to
pe at ten percent. Future shipments are not provided for as yet.
Arain
fash; 18th. Correio carries notice of two cases in Queimados and three in Macahé.

This spoils our State of Ric record.

Dr. WéS& A. calls and has lunch with me at the Office. He con-

firms impressions regarding the mosquito control here secured from studying
the distribu ellow Fever on the map. dyr earlier months of 1929.
By special request to he avoided having to fisoalize the zone of Dr. S,Lima,

However he was given in its place the sone of Dr. Paranhos which also offers
personal difficulties. In the gone of Paranhos, namely, no mar, he found

foci of stegomyia in 25 out of 51 boats, and launches examined. (This in spite
of Dr. Fregas having been informed by the director of the service, JPdeA,

that the service in the bay was perfect!) W. also says that he had occasion
to do a little work in the zone of Jansen and found conditions far from
satisfactory. The railroad yards and line gave many foci, as did al’o the
patios end vacant lots. In one house he found five caixas d&gua which either
had defects in their sealing or were not sealdd, This ins spite of the visit
of the guardas just the day before his inspection. However, on land, but along
the waterfront of Rio, W. found very few or no foci. He has the impression
that thie zone has the best trained personnel in the service, This confirms
the distribution of cases on the map. W. & visit to Ilha das Cobras which is
not included in the above figures revealed that almost all of the lighters and
other craft have foci of stegs. W. recommended to CF the purchase of two
launches for the service in the bay as he believes that it has not been poss-
ible heretofore for the guardas to visit very many boats per day. |

Dr. Amadeu Fialho gives me a nice bunch of tissues for Dr. Kitchen. {CF is in—

a 19th. formed of suspects in Recife and Parahyba.)

ea To Manguinhos early in the afternoon to get tissues for Cowdry
from Torres. Torres gives me tissues from three cases and promises more for
next week, CC says that Guilherme Guinle is furnishing the funds with which
to bring Kugginski to Brazil; that he should arrive here within fifteen or
twenty ddys; that he is to work under the scientific control of the OCI; that
CC does not have any faith in the man and will not permit publication of
results that ard not adequately controlled in any of the official Brazilian
publications, CC again mentions Dr. Fontes of Bahia and says that he fears that
it will be thought that the Foundation did not hire him because his family is
at outs with the family of Dr.BB/

Dr. Zucarini reports that he is going to return to BA by plane
tomorrow and is taking with him virus for experimental work in BAf that iftthe
government does not wish the work done he will destroy the virus;that he hopes
to work in the following manner: inoculate a monkey with virus from Rio and
bleed this monkey to seoure a large amount of dried blood containing virus; this

  
   
  
 
 
 
 
 
 
 
 
  
  

 

 

 

material will be placed in various ampules so that it will be available when

needed in the future. JZ says that he will only have a small number of animals
available; I try to make him see without success the inadequacy of present
methods for diagnosis purposes, He believes it can be done.
6.

April 19th, continued.
HA gives me convaleseent serum from José and Fanny, from
material furnished by us. I confirm for HA the fact that virus has been passed
through the guinea pig. HA picked this information up some days ago here and
as I had not seen any publication on the matter I asked him to find out for
me the source of his information.This he promised to do. HA reports that vaccine
is aghin being produced on a large scale; that he is not fully convinced of
the futility of the procedure and that he is inclined to believe that there
may be some importance to the observation of Hindle that vaccinated monkeys
may develop immnity only after a period of time rather longer than would be
expected, ie one or two months, We discuss the Dodd case and I promise to
make a try for serum. (Should Dodd prove negative and Glover be confirmed as
negative, I believe we should begin to look for some very toxic substance in
the vaccine it self.)

CC says that the Minister of the Interior has given 120
contos for monkeys which he believes should do until the ond of the year.

CF says that a complete inspection was made of the Cop-
acabana Hotel by Pinto Guedes and others and that the only mosquitoes they
were able to find were two or three culex on the first floor and asks that I
send this information to Beeuwkes.

EJdeM and wife dine at 125 Bolivar. It is plain that
he has been working too hard and has been losing sleep, I try to keep the con-
versation off of the subject of yf as much as possible, but with little sue-
cessl J says that he is still keeping statistics on his sone althoug the other
zones have officially given up all attempt to keep track on paper of the actual
conditions in their zonesg J says that two things have come up recently in
his zone that he had not sufficiently evaluated-viz, water boxes and vacant
lots. He says that the labor gang have turned up a surprising amount of ex-
traneous breeding. J reports that rumour has it that Moscoso has been sent to
Copacabana because the fiscalization of Mauricio showed unsatisfactory con-
ditions believed to be due to faulty organization and administration.

April 20th.
Parahyba suspect positive for typhoid oulture (blood){ Annual
Report for Brazil finished to-day about six o'clock in the afternoon,

April 2ist. Sunday. Tiavcry agp tothacs Wikio

Kerr arrives from Buenos Aires on the Almanzora,. ddle and Nas=

on of the Mission oF pap oaemeta are on board. Jacob spends the morning at
Re office taking dictation, Tissues and bloods sent of Vandyck.

April 22. .

Dr. Ernani from Minas appears unexpectedsy at the office. E has
been sent to look over the situation in Carangola where the state service
is nov doing stegomyia control. Three cases of yellow fever are known to
have occurred there all of which were infected in the place. It is now 12
days since the last case end the authorities are beginning to think that
all is over! E. says that Dr. Raul Magalhaes himself handled the situation
in Corynthos that a total of at least seventwen cases, ten fatal, are kmown
to have occurred. Coryntho is estimated to have about seven hundred houses
and is importent from the standpoint of yellowfever epidemiology because of
its peculiar situation as half way point for the poorer passengers of the
railroad. Passengers who are unable to pay for sleeping oar accommodations
buy their tickets to Coryntho, sleep there and then go on the next day to
Pirapora and vice versa. It is also a rest point for sleeping car porters

and other employeés of the railroad company many of whom live in the infect-
ed suburbs of Rio The original infecting case in Coryntho has never been
traced. I suggest to E. that this might be a good point for a small study
and he promises to send me more details as to population, etc.
April 22nd continued. Te
Ernani says that he believes it will be almost im-

possible for him to go to the United States this year because of the y.f
situation. I assure him that if he cannot go this year that I will be all
set to recommend him next year although it will of course be impossible f
for a guarantee to be given as thw action of NY may be uncertain.

E, reports that imported cases have occurred in the
following points bn the State of Minas which are not on my list: Villa
Paraopeba, imported fromCoryntho, Pirapora, imported from Coryntho and ex-
ported to Coryntho, and Porto das Flores on the boundary between Rio and
Minas. ‘ Kerr and I go to Sao Sebastiao. No very typical cases

to show him. poe
- 9
April 23rd. FAO fe ee anew

% Secure names of cases from which tissues weye forwarded lest ~ ., .
year’from Dr. Amadeu Fialho. He says that Albina Xavier/ who died on Feb, “©-~- oa
26th 1929 at HSS was not autopsied according to his books. This case is Gre TIF
one from which Muller isolated leptospira in New York, It is the case on 2... 2°+
which Dr. Connor an ma. a Ognosbs and promised return home , ;. 3y
within a week only to find two days later that she had died suddenly. ay

A long conference today with Mr. Jarrett and Snr, Fayal. It
is decided that Fayal shall be responsible for the downtown storeroom;that
he shall make a nimbered list in order of all boxes entering the storeroom
and shall take them out against Jarret!s order which shall give the number
and date of arrival and ship on which they arrived. Materials shall be tak~
en to and withdrawn from the downtowmm storeroomon Fayal's responsibility.

I shall handle all material inquiries through Mr. Jarrett.

Dr. Kerr and I go to Manguinhos and meet Dr. CC, Costa Lima,
HA, Souza Araujo, and Pena. Also Osorio. Secure a small amount of new *ype
vaccine from HA{ CC says that Kuczinski is to sail from Hamburg today. HA
says he will be working in the other building. When Kueginski lectured in
Berlin on typhus, the chairman refused to put the conference in discussion
as he said nothing had been presented for discussion{ Dr. Rocha Lima wrote
and asked Kucsinski for cultures of his yellow fever organiam shortly after
his original publication. Kuozinski replied that this was unnecessary since
the organism could be so readily obtained in Brazil by using his simple

methods already described.

Present Dr. Kerr to Dr, Fraga, Dr. Pinto Guedes, Dr. S.Uchéa,
Dr. Pego Faria and Alberto da Cunha. I report to Fraga that MEC will
begin service in Alagoinhas, Bom Fim, Nazareth and Joazeiro,in the near fut-

Ure Discuss quite pooroughly the need of autopsies in-the north. CF prom-
ises to get out a cireular to the no ne I promise that our laboratory 1 Va
be glad to examine tissues and give reports on autopsy material; also that “Ex.
we will furnish men to do the autopsies if thefoan be arranged.
Considering the importance of the-loss of complement in yf
eases reported it should be interesting to get a test on the Scot I saw with
Dr. Pyles and who was later reported to be malaria although having an extr-
eme loss of complement, Also serum should be gotten from Dodd case/
I tell Dr. Fraga that I have recently found my notes in regard
to hie need for serum and that every attempt will be made in the next week
or tend ays to get convalescent serum for him!
The Correio de Manha today prints an official article which
sums up very well the defense of the DNSP against newspaper criticism. Dr.
Rangel tells me that all outsiders dying in Rio of yf, even though the y8
is contracted in Rio, are not included in the local statistics. He did not
shy how long one must be in Rio to be considered of Rio. I point out to Dr.
Rangeltthat the grippe curve last year reached its highest point during the
yf period but that it reached its lowest point this year, in fact an unus-
ually low point, just when the yellow fever curve was at the peak.
Flitting is being done in the next block to ours on Bolivar.
8.
April 24th 1929,

Flitting continues in the block next to our house on As

polivere The guardasays the case occurred at number 161, was removed for PA
he flitting but is already in the fifth day and therefore was not re-

moved to any of the hospitals. I call Dr. Pinto Guedes who reports that

the case is suspect{I!! Dr, JAK, Jule and I take injections of immne

serum (José Magalhaes). ee

Dr, Bentes, professor of Hygiene in the Rio de Janeiro i. Aa

Faculty of Medicine, calls at the office and says that he has finally been Arb Beas
made to see the light. He recalls the conversation that Dr. Lessa and we h pent 40,

had some weeks ago in which the prophylaxis of yellow fever was discussed. - [424
He says that he now believes that the emphasis of control should be on the |~ '"° |

 

"policia de focos!He now believes that what is needed here is NO CAIXAS |
pkava WO CALHAS SOME HYDROMETERS AND SME CHBORINATION OF WATERS He
says that Dr. Sampaio Vjanna from a study of the mortality statistics as
they came in week by week saw the possibility of yellow fever existing in

e clinioians and ublic health men recognized ita

presence. SV is reported to have gone to Dry Abreu and caljgd his attention

o the large number of cases that were dying of “hematemis, nephrite, hepa-
tite, and Cholangite’ and suggested the possibility of yellow fewer but was
hot given serious consideration by him. - B. invites me to accompany hié
class to Rio Dro to see one of the water/supplies of Rio.

 

SVU

April 25th.
JAK and I go to HSS early in the morning. Kerr sees an entire-

ly different aspect of yellow fever from that presented on our previous vis-
it when every patient appeared well or only slightly 111. Today he saw

ases, dying cases and dead cases. It is not a pretty sight. We call on Dr.
Seidl and armgange for JAK to have access to the files of the hospital for
working out needed case histories.

To OCI where we lunch with the two Chagas brothers and their
coworkers, and make arrangements for Kerr to have access to the OCI records.
Dr. CBifgives me tissues from his cases 5406, 5406 and 5407 for Dr. Cowdry
part prepared in Zenker's without acetic and part prepared in Regaud's fluid.
HA takes us to the laboratory of Dr. Botafogo Godoy and shows us his new m
models of mosquito breeding traps. First impression is that these will be
helpful in solving the prefenential breeding problem.

&RWerw, RAW is working on some plan for diagnosis of yellow fever.

+ must be from what he says a combination of Kahn and Wassermann reactions,
He himself admits that it is something that may have been tried but that he
will not be satisfied until he knows definitely whether it will work or not,
I loan him "The Newer Knowledge of Bacteriology" to help the fermentation
process and offer to give him laboratory space for anything he wishes to do.

A little slewtennis today for the first time in more than

 

two months.

April 26th.
Dre Kerr spends the day at HSS~ reports that SL has the nurses

records on all cases of yellow fever which he wished to consult,

Mrs, EP returns from Petropolis-reports severe migraines and a
disagreeable time generally. Has had a spot before the right eye some six
months which Dr. Vidal tells her is an old scar and for which he prescribed.
iodine. This she thinks has upset her thyroid balance and caused the onset
of most of her troubles. The eye however is plaanly worrying her although
she says nothing would worry her if she thought it might not get worse than
at present. EP reports that the Crusade against yellow fever is really doing
a very good piece of work;that several very important and able people are
giving much of their time in the administration of its programme; that all
priests in the city were called together by SLeme and instructed to give a
Sunday sermon last Sunday at all masses; that said priests were instructed
in yellow fever control methods and were given an outline already prepared
for their sermons; that all church goers last Sunday were given pamphlets
on yellowfever as they left church last Sunday; that the Protestant minist-
ers and the Jewish rabbis are also at work; that the propaganda among the
school children is already giving good results and the children report to
Ge

April 26th. continued.

their teachers twice per week on the number and kind of foci
they have found; that many of the leading companies here are giving of
personnel, material end funds for the work; that CF originally said that
he did not wish the Crusade to ask the public for any money for the work
but that later he found it impossible to pay their operating expenses
from the yellow fever funds; that in this situation several leading houses
contributed 92 contos overnight. It is also reported that JBB told SLins
that the Crusade had been organized for the purpose of taking the oredit
for the control of yellow fever when such could be accomplished; SL told
Chateaubriand who told everyone else of the Crusade all of whom feel bad-
ly hurt by this accusation. (The Correio de Manha in speaking of the
administrative committee remarked that it would not be necesaary to give
the names as everyone had seen their pictures published so many times that
they were know by heart.)

oo Pduedes gives me the confirmation of » suspe ect case at 161 “A. torat
Boliver; the case was a mild one and PG would like to believe that it was 4 5
not yf. However, it is entirely possible that it is. I offer Con.Serum to

- Mrs,EP for the American nurses who are working here but explain to her that
it cannot be secured for many people.
In conference with CF, guarded inquiry is made as to whether E Se
the RF would consider taking over the control in the state of Rio. I €
state ad my personal opinion, subject to modification after consultation Rix

 

with MEC and FFR that the RF would not consider taking over the state of
Rio without at the same time taking over the states of Espirito Santo,
Minas ond Sflo Paulos CF believes that the first two can probably be arrang-
ed but that S&e Paulo will be impossible as this state has never called on
the Federal government for Health aid in any way. ( I did not tell CF but
S&o Paulo made amquiry almost eight months ago as to whether the RF would
consider cooperating with the state in yf control I do not know whether
it would still be desired or not.) CF insists that SHio Paulo represents a
svery small problem from the point of view of yellow fever control because
g of the temperature range throughout the year. CF says that his big problem
‘is PERSONNEL and that what he needs is more good personnel for the DF, At
‘“X\.wresent he has one hundred twenty men working in the State of Rio and is
furnishing funds end supplies freely for. the work there. CF also says that
RM of Minas asked for fifty more contos the last time he was in Rio. It is
4 apparent that the Federal Govermment is bearing the brunt of the campaign
in the states of Minas and Rio and that it is in a position to practically
‘\ force the state authorities to agree to the RF taking over the service.
CF says that he has already told the Minister that it will be necesaary for
him to take over the Rio service and says that just yesterday he got still
another case from Merity which lies just outside the Federal District and
has been giving cases for months and months now. CF SUGGESTS THAT WE CAN
SAVE THE FACE OF THE STATE HEALTH AUTHORITIES BY LEAVING THEL ISOLATION OF
CASES ,FUMIGATION AND MEDICAL VIGILANCE TO THE STATE AUTHORITIES AND GIVE
TO THE RF ONLY THE ADMINISTRATION OF ANTILARVAL MEASURES, CF SAYS THAT
HAS REPORTED E GOVERNMENT BO ICAL I D_FUMI
TION USELESS. AND THA IS WILLING TO ABANDON THEM BOTH IF THE
IS WILLING TO SUPPORT HIM IN THE MEASURE. ( Galileo was un-
doubtedly right.) I agree to guardedly to Dr. Russell for his
opinion on the expansion so as to have due authorization in case the gov-
ernment wishes to expand the area under Rockefeller control.
I ask CF for permission to ask SL,for confidential diag-
noses of yellow fever cases, This is Be Lena.

woe

 
DISTRIBUTION OF YELLOW FEVER CONTROL RIO DE JANEIRO/.

April 28th.

de Focos

N,

Correio de Manh& gives the following distribution of policia
for the Federal District:

distrioto- Dr, Alexandre Moscoso™ Leme, Copacabana, Ipanema.
distticto- Dr. Silva Pinto- LeBlon, Jardim Botanico and Gavea.

districto- Dr. Merval Soares Pereira® Praia Vermelha, Botafogo
até Macedo Sobrinho, Morro da Viuvea, Beira Mar subindo por Pay-
sand, Ypiranga, Rozo, Guanabara, Alvaro Chaves e dahi aos
morros do Mundo Novo e de D. Martha.

distrioto- Dr, Abelardo Marinho”= Gloria, Cattete, Laranjeiras,
Santa Thereza. 7

districto- Dr. Ramos e Silva= Parte da Gloria e de Santa Thereza
Santo Antonio, Sacramento e S&o José. ~
districto- Dr. Marcondes Romeiro= Candelaria, Santa Rita e Gamboa.

distrjcto~ Dr. Jansen de Mello¥ Parte de Sacramento, Santa Rita e
Gamboa.

districto- Dr. Accacio Pires= Sant'Anna, Espirito Santo (parte),
Engenho Velho (parte)/. y

districto=- Dr, Servulo Lima= Espirito Santo (parte) e Engenho
Velho (parte). an

distkicto- Dr. Clovis Correa“ Engenho Velho (parte), Sao Christ-
oviio, Engenho Novo (parte). y

districto~ Dr. Sylvio Cardoso= Andarahy e Tijuca.

districto- Dr. Nelson Dunhan* Andarahy (parte) ,Tijuca(parteg.
districto- Dr. Alair Antunes= Engenho Novo e Meyer.
districto- Dr, Alvaro Caminha~Zona do Centro de Safide de Inhauma.

districto=- Dr. Queiroz Carrera = Engenho de Dentro, Quintino,
Piedade e Cascadura,.

B, A policia de fécos do Districto Federal ( o resto ) esth
entregue & Directoria de Saneamento Rural.
10.

April 27th. Saturday.

JAK spends the day in HSS again. Yellow Fever reprints
furnished to Dr. Gustavo bssa and promised to Dr. Antonio Monteiro, Filho.
Deliver Hudson paper on pathology to HOC for Dr. Evandro Chagas and see CC
who believes the looal situation is improving. ,

Dr.BB spoke yesterday to the Rotary Club explaining a
some of the difficulties in the practice of yellow fever control as compar-
ed with the simplicity of the fordula for control. His talk is published in
QO gORNAL today. BB emphasizes the difficulties of adequate vigilancia med-
ica and the impossibilety of fumigation of all infeteted houses. Get two
om 8

blood containers laboratory in his absence for use tomorrow.

April 28th. Sunday.
JAK, JTA and I engaged in a quiet blood hunt from 9 to

13 o'clock today. The results were not too good but still the one victim
that we found was quite willing and let me stick him twice. Hfortunately
the needles clogged very soon both times and the amount of blood taken was
less than we had hoped to get. However, I left him my name and addreds and
he promised to come in and get bled again in abbatt a month, The victim's
name is Arthur Pereira, R. Bar&e de S&o Felix ,166. (Dr. Tomaz and I went
back into the maze of houses which are approached through No. 152 in the
same street. This was indeed a treat for my slumming instincts. Many small
houses crowded in thickly, many of them under one and the same roof, each
with only one or two small roams and with little provision for sanitation,
should give ideal conditions for the propagation of all sorts of communicable
disease. This side trip gave us no results except the very confidential in-
formation regarding one case that we were interested in, that the condition
diagnosed as yellow fever and which caused her entry in the hospital was not
yf at all but a suspens&ol Imagine! It is quite plain from talkingto one

or two of the people here that they do not want to think of yellow fever;
that they believe that there have been very few or no cases of yellow feverg
that in their minds all cases of yf are necessarily fatal &nd that therefore
anyone removed to the Hospital who does not die was removed without reason;
that the health doctors know nothing about yellow fever but are prone to
send 6veryone that has a headache toe the hospital; one woman told us that
she herself had had a headache and a cough and had cured it with a medicine
from the pharmacy just about the time that the other cases were removed from
this zone. As JTA and I are returning to the car we stop out of the rain
under a shed which is being used for the preparation of fiber for the hand
manufacture of rope. Five or six Bortuguese were laboring here and were mak-~-
ing a very smooth even rope which had every appearance of having been made
by machinery. However, difficulties are in sight for these workers because
the country is now beginning to manufacture rope from the local fiber by
machinery and onee this industry is established an import tax will be placed
o n foreign fiber which will force them out of the business.)

Flitting is being done today on_Barata Ribeiro just the
other side of Barfie de Ipanema. Confidential information from one of the
guardas is to the effect that the patient causing this flitation is the
lady of the house, that she has been living here for some time and that the
case which was originally suspect has finally been confirmed,

April 29th,
Antonio Paulino Farias, Marechal Floriano Peixoto 196, came to

the office today and was bled for about 400 c.cm. Unfortunately a drop of
saliva worked down into the container and may have contaminated the whole
lot. This man says he will be willing to give more blood later.

The Crane representative in Brazil appears at the office and
gives some information and catalogues about their products. These are given
to Mrs.EPt to be passed on to Dr. Souza Aguiar.

Degivered Pereira and Farias bloods to MA who says that by
fractioning at least part of the latter may be saved. HA admits that the o
one monkey that he tried to protect with the last vaccine died of yellow
fever, HA is not at all convinced of the absence of virus inthe brain and
kidney as stated by Hindle, HA says that several attempts were made at
yo | ll. »

April 29th. continued
.OCI to get complement deviation with yf serum,
He is not sure how many antigens were tried but knows that both human
and monkey liver were used. Dr. Chaves comes into the lab and HA offers
to sell him a large box of quinine which he has in the cornerI!IIIIIt!
. q C says that almost two months ago he and his wife made a call in the R.

- do Bispo; that while making this call his wife knew that she was mosquito
bitten; that’ five days later she had a severe attack of what the family
physician finally diagnosed as angiocolitis.However, the symptoms were
very much like those of yellow fever except for the vomiting which was not

: present, Albuminuria was appreciable. After her recovery C began to think
. that she had probably had an attack of yf.
f i . Delivered collection of yellow fever reprints to Dr. Miguel for
Dre Monteiro,Filho, and suggested that he also take advantage of them. At
( ~' HSS find that the man who had apparently recovered and then began running
, a high fever is in a dying conditiow. Nair Estefania who¢g came into the
hospital to take care of her brother is showing fever and congestion of the
eyes today. Blood specimens are taken from her and from Johanna Correa
who is taking care of her son and her niece both of whom have yf. Johanna
says that she had an attack of grippe about two months ago but was only in
* bed about three days.

“ April 50th.

-. Wire received from FFR stating that RF has no objection to
° ‘grterting contract to include the states of Minas;Espirito Santo and Rio |
so to sail May 4th. >

Spend much of the afternoon with Dr. Amadeu Fpathe in an Epa
attempt to get a blood specimen from Nair dried cold. Learn that he has Kop’ a
tissues from Albina Xavier Coutinho. AF discusses the possibilities of. - oe
getting help for the pathological stitute of the Faculty of Medicine Jkt wes
from the RF, I plead ignorance of all things pertaining to the field of peek
Medical Education but offer to accept information and requests for trans- oo) cis fm,
mittal to NY. ° mo4 x4 Se
’ q SLsays that he met Kerr at the hospital and gave him most of “4 CER
the desired nurses records of the cases we need. He insists that only dur- =
ing 4 very. short time did he aid in covering up any diagnoses or hiding the
number of yellow fever cases actually going to the hospital; that when the
first cases began to come in in 1929 from Braz de Pinna that CF required
that only clinically frank yellow fever should be diagnosed and that any~
thing which was open to the least suspicion should not be so classified.
SL says that possibly some six or eight cases were were Eeven. Giagnoses with
' question marks; that since se early cases 368 00 sovankng not more than two
or three weeks that all positive cases were so diagnosed by him and that
his plus mark oan be found on all sheets considered positive by him, I
_ explain to SL that I need the information of diagnosis not to be able to
‘say how many cases ocourred during the present epidemic but to facilitate
the choloe of oonvalescents for donors of convalescent serum. SL assures
‘me that I can have absolute confidence in the indications found on the
charts as to his opinion of the cases withthe exception of the few cases
above mentioned;that he considers the forma frustra of yellow fever mark-
ed by headache fever and albuminuria with casts just as definite clinic-
ally as the typical case with jaundice, etc.
( The Corrko carries an interesting news item under the title:
"Uma contra-dansa na Saude Publica" . The following changes in the DNSP
have been approved and the necessary decrees have been signed by the Min-
ister of the Interior:
Dr. Jose Placido Barbosa, fron TB to Prophylaxia.
Dr. Jo&o Pedroso Barreto de Albuquerque, from Prophylaxia to TB.
Dr. Alberto Viektra da Cunha, Dir. Serv. San. to Dir. Defesa Maritima.
Dr. Mauricio de Abreu, by request, dismissed as general secretary.
q . Dr. Jofio Pedro de Albuquerque, dismissed as Dir. Defesa Maritima.
Dr.-Alvaro Barreto Praguer, nominated as technical assistant in TB.

 

Many interesting comments are heard on all sides regarding the reasons
for the above changes. Some say that Pedroso felt hurt when CF took direct
charge of the yf campaign last year and that as a result he has never given