O56

July 28. Dr. SUchoa and wife luch at 125 Bolivar and later in the afternoon
Visit Ttijuca, Vista Chineza etc. SU expects to sail for the north abouththe
15th of the month.

July 29th, ALBB from Bahia calls at the office; his first greeting is rather
riendly but the situation suddenly turns chilly when I refuse to order scales
for his service to be imported duty free. I explain just what our understand-
ing is with the goverrment but he is not interested in explanations, only in
not paying the duties. We discuss practically nothing and BB leaves coldly and
even repels the susrestion that I should see him at the boat at the time of
his departure. To OCI and learn that culture given by K to. CC was apparently
dead and was probably a recently transplanted cllture as the tube gave no evi-
‘dence of prliferation within the culture medium.

July 30, Magé- bleed 44.

July 31. Jayme Pereira and femily sail for New York, JP believs that with
almost any possible change in government that Paula Souza will return to the
Health Department. And of course the government must change in Septemher as
Julio Prestes is a candidate for the National Presidency and must leave his
present office six months before the election which occurs in March.

ALBB seen on boat-very cold and distant even to the point of veiled
insult, eet Mrs. Ridgeway and two children on Boat. Ridgeway is now in BA.

CF states that a new credit of '8,000:000$ has been opened for yf.
Aurust 1. Magé-bleed 42.

August 2. HA reports that K presented second apparently dead culture to CC.
f course the answer to that is that CC is not cavable of keeping alive the va
culture of K. K has reported that his work is being confirmed in England.

Decio Parreiras has submitted to CF a budget for the state of Rio in
the amount of 6:000s000$000 for yf control. It is understood that this budget
berins to operate in the present month of August.

Informed CF that MEC is withdrawing services fran the interior of the
state of Bahia. Promise monkeys to Penido for trachoma work. OCF states that
Minister of Interior has received complaints from Pernambuco that the service
in the interior of that state is not adequate. CF requests that I wire MEC
suggesting that the service in Pernambuco be intnsified.

WSAntunes lunches at 12 Av. Ruy Barbosa. Nothing new in YF,

August 5. Wires received from both MEC and NCD regarding possible gallbladder
overation, also regarding visit of Rocha Lima to the laboratory in Bahia.
All day in office. Miss Owens from Kansas appears, KU 1901.

LaFayette de F Freits calls about Antonio Ignacio who later appears
in person with his wife. I go over the situation with him in detail and try to
make it clear that under the present regime there is little possibility of our
being able to arrange any subsidy for his services in Recife. I make it clear
that we expect these services to continue as in the past but that we do not feel
that we should oay for them. He assures me that there will be no change in our
future relations end that he will continue to do everything possible to aid and
assist in carryvine out the yf programme in Pernembuoo.

Wires mentioned above were one from MRC askinga about suitable surgeans
for Davis gallbladder in September and one from Davis saying MEC telegram had been
sent without his knowledge;both MEC and NCD insist that news should not be for-
warded to FFR. Rochh Lima wire made enquiry as to intentions of RL regarding
monkey inoculations. °
36.

August 5. Andrade and Ferreira Pinto shamefacedly admit but thirteen bloods
for last Saturday and attribute their hard luck to their inability to hit the
veins. Following wire received late in the afternnon fran NY "Following received
quote returning Europe offer exchange full installation antimaryl cultural work
Kuezunski unquote not answered no vacancies in our organization request reprints
you deal with him."

Ferreira Pinto takes Pereira Netto to OCI and bleeds him; he and I
bleed Mr. McArthur, Senador Vergueiro 68.

Pyles refers to the Momsen child as having an attack of something
which may have been yellow fever and sugzests bleeding.

Wire received from New York stating that_K has offered to go to NY
to explain everything there. I am authorized to treat with him but with the injunct-
ion that there are no vacancies with the Foundation,

Visit dentist and am advised to have tooth out.

ducust 6. To Mee-forty one people bled.

August 7. Taking Dr. Tomaz with me, Tgo to Manguinhos to interview Kucginski. K
fakes pains to explain that he sent the wire direct to NY only on the edvice of
tvo friertis who were very much interested in his work. The only friend he ment-
ions however is Dr, Selwyn-Clarke, who, he says, spent a couple of weeks with him
in Berlin and had an opportunity to appreciate at first hand his work and his re-
sults. His two friends, including Clarke, had insisted that he take the matter
direct to headquarters by cabling New York. (K evidently thought that I would be
irritated at his attempt to go around me; however, Ibelieve he is no longer able
to irritate me about anything as I know more or less what to expect from him.)

It seems that the Foundation has more money to spend on yellow fever research than
anyone else and he thinks that his great discovery should be presented to the RF
under such circumstances that would admit of rapid confirmation by an able group
of investigators. At the OCI he has been unable to secure any cooperation until
quite recently with the return of Dr. Chagas. When pressed to state his price, K
refuses to do so but believes that living expenses in NY are probably higher than
in Berlin; he should have sufficient for himself and his technician to live can-
fortably there during the time required for his demonstration. K says that he
wishes to vindicate himself to the RF because he knows that the RF is skeptical
regarding his work and he has received a letter fram a prominent scientist (name
not stated but probably Rocha Lima) who says that neither the Pasteur Institute
nor the Rockefé@ler Foundation have any faith hh his works. I almost replied thab
faith without works is dead but refrained. The upshot of our conversation was that
I told K I would transmit the details of our conversation to NY and would inform
him if and when I received any further instructions fran NY,

Following the discussion with K, Dr. Tomaz and I call on CC and place the
whole situation before him. B says that the culture is now in the hands of CCruz
and that within a very few days we will kmow the worst, It is believed that the
first cultures given were dead but cultures are now growing in various media. CC
expects that a few more days will tell the tale and promises that he will take
pains to let the scientific world know gust what the results of K's demonstration
at OCI were; CC says that K has been placed absolutely in his hands by Guinle. (QF
course Guinle has not yet received the news fram Africa that K is here at the
request of and paid by the Rockefeller Foundation.)

Oswino Penna calls at the office and inquires regarding the remarks of H HA
on his publication of Councilman's re,ort. My only reply is thet HA had suggested
that Rocha Lima had been misinterpreted and was given credit for saying things
that had never been said. ‘

May report to cr/ Learn that DNSP has been paying on monkeys to the Cia.
Docas de Bahia each month in spite of our labors to the contrary in January.

August 8. Magé-37 persons bled.

August (9). Take bloods to Mnguinhos. K HA reports that RL would like to make the
trip to Bahia as part of the trip to Fecife for the Congress of H ygiene.

CF given copies of our correspondence with the Minister of Viagéio
regarding monkey importations.
oT.

August 10.

Ferreira Pinto to Mage alone-collects nine bloods.

Andrade and Maneco Ferreira both cane to the office highly ex~
cited over the most recent desaforo of the secretary of the depart ment of |
Hygiene in Nichteroy. Yesterday he p sted a notice that the servents of the
department were not to attend any of the wants of the CR;today a notice went
up stipulating that AA was meant to be included in the personnel of the CR
AA had discussed the first portaria with Lintz but has not yet discussed the
second one. I authorize AA to invite Dr. Lintz to call on me again.

Call on Rangel to see system of filing cases of yf in Eardex; and
on Amadeu Fialho to secure names of cases from which tissues were forwarded to
NY.

To Circus party at Country Club.

August 11. Quiet day at hame with the old folks.

August 12. lLintz has said that there is no reason to call on me until he has
tater up the matter with the secretary or the president of the state. I find it
hard to believe that any director of a service can be so molhe in regard to his
subordinate personnel!

HA reports that he was recently able to infect monkey with fourth
day mosquito. HA furnishes copy of RL letter to K written in German on J uly
19. (This to counteract the remarks made to me about some scientist who had
written to K about the Rockefeller Foundation.)

Hear Valery-Radot, grandson of Pasteur lecture on Widal and his work.

August 15. ¢
Raul Magalhaes calls at the office and agrees that the_need of the. /

RF for stimulation in the county health progremne of the stat of Minas is pasta
owever he is very desirous of securing th continued cooperation of the RF in

the state even though it should be on a reduced scale. I indidate the possible
entry into other types of service, such as statistics.

AA reports that he and Ferreira Pinto called on the secretary of the ;
state yesterday and that Lintz and Decio did so immediately thereafter. To- Ly
day another round of sessions is to be instituted to attempt to clear up the
situation.

Raul Magalhaes reports that a suspect case of yellow fever occurred
recently in Juiz de Fora, Onset day following arrival from Rio de Janeiro where

patient lived in Rua Francisco Eugenio.

August 14th, Ferreira Pinto reports a total of thirty bloods from Beé yester~
ay. This makes a grand total of six hundred twenty two people bled there.

AA reports that the secretary of the department brought official
chhrges against him to the Sect- of the State. He does not say what these charges
Were but I gather that they had to do with remarks that had been made by AA and
reported to the secretary. AA to go to Nichteroy again today. Lunched with the
Federal Deputy fron Macahé and insists that he can bring heavy political pressure
to bear if necessary. i

EP“reports that IM’is very easily influenced by others. Now under
influence of SE: both believe that they are the only ones with either ideals or
ability. SE to go on leave Aug. 23 but does not care to discuss plans for vacation
at this time.

Conference with CF. Says that there have occurred in the past two
days two suspects the first of which proved to be gastroenteritis on autopsy and
ree other of which recovered. The latter case came from the Rua General Polydoro

Discuss various phases of yf with Waldemar, Lafayette and Uhoa.

AA reports that another(the third) portaria atuwacking the RF bas
appeardd in Nichteroy. The Secretary of State has decided that the entire quest-
ion of this misunderstanding should be setthéd by Lintz and Soper in conference.

apaust isth. NCD writes under date of August 9th thet AWB is ill second day of
what seans to be a serious illness.
58.

August 16th. Wire fram Mec confirms BURKE as yellow fever with monkey inoc-
ulations. AWB probably infected in laboratory on Au7ust 4th, onset Aug. 7th,
returned to work August 12th,

August 17th, Lintz calls on telephdne late in evening and arranges to call to
‘see me on Monday Aug. 19th. FP*to Magé alone.

JTA and I visit HHS where we find a suspect case of yf fram the
R. Damingos Fernenttes, Madureira. Does not look like yf. Noite reports a case
removed from the R. General Caldwell.

August 18th. Sunday. Worked in AM at home. AA calls and gives details of
Wichteroy situation.

August 19th. Drs. Lintz and Hecio ¢all at office and invite me to call on the
secretary of the State of RIC with+them in the afternoon to discuss the sit-
uation in the state caused by AAvand VM. I accept and spend the hours from

four to eight making the trip. Decio does not show up but Lintz and I go to the
Secretary's office and discuss the situation. After thorough discussion of the
situation in which it appears that AA should have taken the matter to Lintz in
an officio instead of taking it to him difect. It has also been charged that

the first officio was take by forso and that therein AA had acted against the
proper procedure in such cases. The solution offered of the crosent case is

that the Secretary has already ordered the author of the offending document to
take it dovm from the wall and is disregarding entirely his petition for punish-
ment of AAs furthermore, AA will be given an office apart with separate telephone
and separate servant. (The suggestion is made that the removal of Martins akould
be accompanied by the removal of Andrade!!!) I accept the solution offered as
the Secretary gives all kinds of assurances that he is with us body and soul

but that he feels that there is a certain amount of error on both sides.

August 20th. AA advised of yesterday's conference and told that he may re-
turn to Nichteroy where he is to have a separate office and a separate telephone
and servant. Later in the evening he calls me on the phone and reports that his
new office is the room previously used as a deposit because it is right next to
the latrine and hence not desireable because of penetrating odors. He further-~
more states that the notice written by VM is still on the wall contrary to the
orders of the Secretary and that Lintz is not giving him a servant but is offer-
ing to pay the magnificent sum of one hundred eighty milreis per month toward
hiring a servant.

August 21. Receive wire from FFR stating that another ntonintelligible cable

has been received in New York from Kuczinski and suggesting that I treat with
him again. Prepare officio for thé Secretary of State of Rio end also one for
Dr. Lintz calling attention to the failure to remove the offending document from
the wall in Rio and saying that we will be unable to use our office there as long
as the author of the note is @mployed in the department. A copy of the note to
Lintz as well as a copy of the offending document are sent to the secretary in
charge of Dr. Ferreira Pinté on August 22nd. Give specimen of convalescent serum
to Dr. Fox, Professor of Skin at Columbia (7) to take to Davis in Bahia,

August 22. Offending paper still on wall in Nichteroy. Document sent to Sec. |
by Br. F/7P. as stated in yesterday's diary; to Lintz by registered letter, C¢

eX .
Prof. D. Matthews of Forestry at ANN ARBOR and Chief Forester Cg” and family V/22 [2G -
arrive. Rrof. Matthews to dinner with Dawson's and Halls, = ~~ © AT
Dr. Oswino Penna calls and is very curious to know the reception of
his article on yellow fever pathology in New York.

“~———"—Gonference with CF; agreed no fellowship for Muniz Arig&é this ‘
year since both the Foundetion and he would prefer next year; discuss situation /
in state of Rio frankly; CF says that he accepted the decision of the government
to maintain Lintz there only because he felt that he owed a political debt to

WL at a moment when an attempt was being made to overthrown the actual regime,
SoA
596

seas 22. Continued. CF states quite plainly his impression of Lintz as an
admir stracor which coincides rather remarkably well with mine after the events

. i
}

of the past few weeks. CF says that the Ministry has not yet taken action in
regard to the importation of monkeys in Bahia but assures me that BB will be
given instructions to continue paying the bills as they are presented. CF is
to attend the Congress in Recife.

Ausust 23. Confidential report received that action has been taken in the case
of the secretary VM who has been causing so much difficulty in the state of Rio.
Report has it that the Secretary of State took drastic action in spite of unavail-
ing protests of Lintz.

Take train at (9PM) fo Sfo Paulo. SR

 

August 24th, Mot at train by Dr. Paula Souza who apvears in good health, Later
spend a couple of houss with him at the Institute swapoing impressions on the
League of Nations situation and on the Bragilian situation. PS says that the
most level headed man in Europe today in GKS/ PS says that the rumour is going
arovid that Mario Pernambuco sot mway with some eight hundred contos of the RF.

Conference with MP and Waldemar de Rochh in regard to the payment of the SP
accounts. MP asks for and receives a letter dated August lst giving the debit
with us of the county of Candidé Motta; MP issbists that there is an account of
Sert&ozinho of 5:655$100 which has been entered twice in the accounts, Also
eclls attention to the fact that Piricicaba has paid its debt of something over
eight contos which was paid by WR the last time he was in Rio.

Dr. Pedro Dias lunches with me. Nobhing particularly new lcarned on

the local political tHWeastion . Call on both Neiva and Rocha Lima. RL to go
to Bahia on the Southern Prince the first few days of October and then proceed
to Recife. Dine at home of Dr. Paula Souza. °

August 26th. Sunday. Spend three hours going over the new Faculty of Medicine
with Dr. Pedro Dias and Dr. Souza de Campos. Lunch with Dr. WO who has as guest
Dr. Figueira de Mello, from someplace in the North of Brazil and who now has the
same place in the department thet WO previously occupied.

Sleep in the afternoon,

Aupust 26th . Spend forenoon with Dr. Paula Souza at the Institute seeing how

they are built. Lunch with Dr. Rochalima at the Hotel Aurora. Dr, Rocha Lima
is beginning to take lessons in English. After lunch return to the Hotel and
await the coming of Waldomiro marked for five oclock. WO does not come. Dine with
Pedro Dias and Souza Campos at the home of Pedro Dias: a great long jantar of
some seven or eight heavy courses followed by an evening of music with Dona
Julieta #t the piano. Very little of value learned aside from the fact that Julio
Prestes made Pedro Dias a present of the new ford which he is driving. I admit
the possibility of this gift but also cail attention to the fact that Pedro Dias
only began to drive this car after the constru ction of the new medical school was
well under way; to this sally Pedro Dias responds that the most serious thins is
that Souza Campos is building or has built a new house. Souza Campos insists that
he was careful to make ay¥l purchases for his house from dealers who were not
furnishing material for theschocl to which I reply that his very care on this
point outs him under suspicicr., Return to the hotel at Midnight after an evening
of Chppin, Liszt, Bach, and Aloysio de Castro!

August 27th. Spend the morning at the !otel. Dr. an? Mrs, Pernambue: Jonoh with
TE» “~~ MP sys chat Pedro Dias is justif#dd in his complaints on the loss
of clientele after going to the medical school. MP explains it as due to the free
talking of the medical students regarding the kind of instruction that he is able
to pive them. including one

WO asks for three fellowships for himself. He says that he expects
to leave the Birectorship of the Sanitary Service when Julio Prestes gets out;
that he did not request the appointment in the state of Sao Paulo and that he
will not request any appointment for Rio de Janeiro; that he does not know
whether he will be taken to Rio or not and if taken does not know in what cap-
acity he may go. In the meantime he has become very much interested in the sub-
40.
ject of nutrition and would like me to secure for him from Dr. Russell the
promise of a fellowship to study nutrition. I explain to him very carefully
that there -re no funds available for fellowships this year but that we
expect to have funds availbble for 1930. However, I stress my doubts of the
possibility of securing from the RF in New York fellowships for the state
of SHo Paulo for anyone who is not a full time employee of the Health De-
partment; WO comes back to this point later and stresses the fact that he is
a Delegado de Saude and hence effectivos;he does not discuss the point of
full time. In regard to his fellowship I am forced to point out that not
even Dr. Russell has authority to grant him «a fellowship at the present time
to teke effect after he has left his present position; that before all else
the Foundation requires the recommendation of the Director of the Service
and as no one knows at the present time who his future chief will be, no
steps can be taken at the present time to guarantee anything.

Dine at an Italian restaurant with Borges Vieira, Lucas Assumption and
two otheryoung doctors, all of whom with Rocha Lima and Waldemar de Rocha
are at the train to despedir me. Take train at nine oclock and refuse to
pay ten milreis for a bottle of Caxambu.

August 28.

Arrive in Rio nine AM. Among others find the following letter which
at least indicates that opinions differ.
Caixa Postal, 387.
Bahia August 21 1929,
Dear Dr. Connor:

We received today about forty thousand of the enclosed folders,
a recommendation by Dr. Clementino Fraga, advising the use of fish in mosquito
control, I presume the purpose is to ha ve the guardas distribute these sheets
from house to house.

Personally, I do not see what good will be accomplished by
their distribution, There is no objection whatever here to the use of fish.
The public accent them as a matter of course, following years of custom. Dr.
Sebastiaio'Barroso's bolshevistic explosion has apparently been forgotten,

The only question is how much we wis: ‘c spend in the distribution of fish.
We are convinced, I believe, after a very fair trial, that the public will
not aid us in this enterprise. Do we then, want to distribute fish to tinhas,
talhas, and similar deposits, as recommended by Dr. Fraga, and, if not, why
the propaganda? I think we are already spending more money on fish than the
results warrant. We know from experience that we areobliged to fish large,
permanent, otherwise unprotectable deposits such astanques, and caixas; but if
we are going to extend this service to include tinhas , talhas, barris,
porroes, and the like, it will cost considerable money, and in no way aid the
campaign.

I shal await your instructions in the matter,

Very sincerely yours, AWBurke.

The situation in the State of Rio remains unchanged. AA is working in the Rio
office. )

August 29.

 

I submit personally the June report for the Yellow Fever Service
to Dr. Fraga. Visit to Davis for preliminary discussion of rental of house.

Nayiet hej:

Inspect for the first time the foci map of Rio. According to this
map the centre of the city is clean whereas the outlying districts show many
foci. WSA reports he has been unable to find foci in the centre of town but
that today he found forty foci in outlying districts. (This may not mean
very much, however, as it is entirely possible that the majority of these foci

were culex.)
Conference CF. CF announces purpose of consecrating his administration .
aN CE hag ee ane Tan mere me wt

et mime Tt a ep at en .

August 30.

 

et ms
a.

i
eos

41. vid
to the problem of yellow fever. I called his attention to the fact that (yd
we have receive Sonfirmeation « of cases recently in “Venezuela and that 14 ae

Colombia is probably infected although complete confirmation has not been” -

 

possible. CF does not seem to realise the possible significance of this. eRe VU
unexplained reappearance | in, “these other countries.

CF states that he « expects “to start to Par& about September 15 and
will visit as much of the north as possible before attending the Hygiene
Congress in Recife.

CF suggests that the Foundation re-present the accounts of last year
which are in exercisiss findas.
August 31.

Wire MEC of possible trip of CF to Para.
September 1. we
Sunday. Cox family to dinner.
September 2.
CF assures me he cannot leave Rio before September 21.
Again suggests re-presentation of 1928 account with a letter stating that
the Foundation is desisting from the collection of that account.
September 3.
Later Joke Receive one ; telephone call, one note and two visits to inform me

that there is a suspect gas gase of yf at_ “the ‘Ass. That speaks ‘pretty well for
peek fests our secret service organization. Visit the hospital with Dr. Tomaz Alves
McctlerBy- and find that the case, the first in seven weeks, is already dead. There
is no history of the patient having been away from the central part of the
city for some days and he resided at the Hotel Sublime very close to the
Hotel Central. Diagnosis confirmed by autopsy. (For political purposes
this first case after the interval should have occurred in Nictheroy or some
other point of the state of Rio. )
Authorise AA to request audience with presiddant of the State of Rio.
Jansen de Mellots to dinner.

September 4.
ellow Fever case died yesterday at HSS. Italian from Sublime
Hotel, Coes: Verge 83)

September 5.
Conference with Decio regarding situation in State of Rio.
Decio proposes integration of Malaria Service as solution of present difficulties.

September 6.
To OCI with Cox and Matthews. Penido shows experimental

trachoma in both human and monkey subjects. These cases are L both direct
transfers from a human case. Fenelon acy 104 def ate

September Te
Holiday. Office all day.

September &.
Sunday.

September 9.
Letter No. 19) written to Dr. F. F. Russell (see pp. la-kle for
letter and answer.
f/@-

cOoPY

No, 1494 9th September, 190

a

 

Dear Dr. Russell:

Your letter of August 16th regarding the studies in
Magé wame as somewhat of a surprise to me. The idea of attacking
the epidemiology of yellow fever from the stand point of immunity
distribution in a given population has appealed to me since rather
early in the Rio epidemic. When yellow fever occurred in Braz
de Pina, a suburb of Rio de Janeiro, in December of last year, Dr.
Muench and I planned on an epidemiologies] study of the place. ‘We
spent sone time in making a map and gothering certain preliminary
information. However, before this work had gone vory far, it so
came necessary for Dr. Muench to go to Pard and other interests
prevented my going on with the study. nly f ur sera were sent
in from Braz de Pina but the results were very interesting. You
will find them commented on in my letter Wo, 1309 of May 24th.

Braz a
ies

e Pina is a small suburb of Pio where much
difficulty in gett b
ce

ing blood specimens was anticipated, As the
yellow fever infection spread to various places in the interior,
it appeared thet a more clear-cut study could be made in cormunitie
where the date of the introduction of the disease might be rather
definitely esteblishsd and where repeated invasions had rot occurred.
From this standpoins, I had considered the possibility of wor’ing
in Coryntho, Minas Geraes or in Magé in the state of Rio. Cor
trary to the inference draywm in your letter, Mage was not chosen
because of any interest in Megé as such. Magé was chosen because
accurate maps and other information were available from the time
of Dr. Boydts Malaria Service there. Another fector of prime
inrportance in causing the selection of Magé was that the doctor
who had already directed the Malaria Service was available to
assist in the study You can readily appreciate some of the
difficulties connected with getting a large mupber of sera from
the general population; Dr. Ferreira Pinto'ts personal friendshics
have proven invaluable in this resvect.

numy letter of Avril 18th I wrote you as follows:—

"after corcfal considerssion of the ~ossibilities
here I wish to sugzest the following for your con.
sideration:—

1, That we maxe an athemgyt to study curefully
from an epidemiological standpoint one infected
zone in the Federal District and one infected
torn of the interior.

ce Thet as part of this vtudy we teke blood
specimens (20 to 25 c.c.) from as large a number
of individuals as possible.

ve That we install c« small laboratory where
serum can be separated from the above specinens
and prepared for exemination at any time in the
future wherever monkeys and gersonnel are aveil.
able."

abe
nH

Probably I should have been more specific under 2. above;
ib

what I really wished to suggest was "that as part of this study we
take blood specimens from as large a number of individuals from the
general population as possible".

Your letter opens the whole question of the epidemiology
of yellow fever in Brazil to discussion. At the present time, there
is no generally accepted criterion for determining whether, in a
given community, control measures should be undertaken or not. For
example, Estancia and Mag6é are oases in point. As you will remember,
the first case of yellow fever diagnosed in Brazil in 1928 occurred at ~
Estancia in the State of Sergipe. The autopsy and epidemiological
investigations were made by our service; although the autopsy was
later proven positive, from epidemiological studies of conditions in
Estancia before and after this case, Dr. Connor did not believe the
case to have been yellow fever. Dr. Connor was unable to find any
logéal history of yellow fever during a period of at least fifteen years
and therefore assumed that the nonimmune element gf the population
must be suffieiently large to guarantee further diagnosable cases were
this case truly yellow fever. - Dr. Fraga, who saw a case of yellow
fever some years ago in Bahia which had originated in Estancia, con—
sidered Estancia a dangerous focus and insisted that control measures
be instituted. Dr. Connor refused to institute control measures be—
lieving that the case was not yellow fever. Absolutely no control
measures were taken in Estancia and, as far as is known, no further
- gases have occurred. However, had an immediate diagnosis been av—
ailable, control measures would probably have been taken the the ab—
sence of future cases attributed to syoh control measures.

 

 

 

In Magé, on the other hand, rumours of yellow fever have
been traced back as early as December, 1928. The first known positive
cases occurred about the midd&e of February, 1929. However, no control
measures were taken until March 2lst, The apparent results of control
measures were almost immediate; Dr. dDel Negro, who was in charge of
these control measures, is the first to suggest thet the cessation
of the epidemic was probably not due to the measures of control. As
you will see from the accompanying map, the twenty one cases admitted
as: suspect by the Heath Authorities are widely scattered in the heavily
populated part of the town. The anti-—mosquito service in Magé has
been maintained during the winter season and will undoubtedly be
continued more or less indefinitely, whereas other towns of the same
size which have not produced cases of yellow fever are without
such service. If anti-mosquito services mist be maintained indef—
initely in all small towns where yelléw fever occurs, the elimination
of yellow fever will probably prove impossible because of tack of
funds. (Dr. Connor has adopted for North Brazil the pokicy of
inaugurating control mrasures in the smaller interior points only
when yellow fever is proven to exist and of abandoning such measures
when the apparent danger is over.) Is it not possible thet towns
where yellow fever has not yet appeared represent greeter potential
dangers than does Magé where there may be a lerge immune population?

From a theoretical standpoint, the percentage of immunity
in a given populetion may be almost as important a factor in limiting
the spread of yellow fever as is the mosquito index. In fact, the
entire program of control of yellow fever in a district by controlling
posquitoes only in the larger centres of populstion is based on this
principle.
efi c-

The importance of the mild undiagnosable case of yellow
fever has been appropriately emphasised only since the demonstration
that Macacus rhesus can be infected with the yellow fever virus.

It is true that some of the eglter clinical destriptions of the
disease called attention to such eases but these were in general
disregarded in actual epidemiological investigations. It would be
of the greatest value to know what percentage of cases of yellow
fever are mila@ and not capable of clinical diagnosis in different
age, race and nationality groups. Dr. Wilson has recently reported
@ small epidemic from the interior of Pernambuco in which fifty—

eight cases with eighteen deaths sre reported to have ocaurred in
2 population of one_himdred end seven people. Records are also
available of ship infections where a large percentage of the crews
were attacked with a high mortality. In the oase of ship crews,
we are dealing with a foreign population and in Dr. Wilson's efi-
demic we are dealing with an interior town where the population is
probably of Indian blood and may be, for purposes of yellow fever
studies, entirely distinet from the population living in the
coastal regions of Brazil. Similer high incidence has not been
observed in native population here during the recent outbreak.

Many of the details of the present epidemic in South
Brazil are explainable only on the assumption that the virus of
yellow fever may behave somewhat as does the virus of polic-myelitis
in which disease only a small percentage of individuals show character—
istic lesions of the infection. I believe it has been demonstrated
in the laboratory that the virus of yellow fever may undergo cefinite
changes of virulence. May the same thing not occur in nature?’ It
has been interesting during the present winter season in Rio to note
that a number of warm days following a cool spell produce a few
suspect vases of which none can be definitealy diagnosed as yellow
fever but that with the return of cooler weather, not even suspect
eases arc reported.

Most of our knowledge of yellow fever in Endemic areas
has come from observations made on cases occurfing in adtilts more or
less recently arrived from nor-endemic areas; previous to the dis—
covery that M. rhesus may be infected there was no satisfactory nd spor ML
method of studying yellow fever epidemiologically since jonly fatal ne ken,
gases could De delenit vet cont immeds When yellow fever reappeared neeipatl,
n Rio de Janeiro in 1928 after an apparent absence of twenty years,
the local authorities anticipated a high incidence of the disease
among natives of the city in the younger age groups; however, such
wes not the case, the disease being apparently limited largely to
recently arrived foreigners and to Brazilians who had come to Rio
fyom other parts of the country. Some would interpret this un-
expected distribution to indicate that yellow fever has never been
absent from the Capital and that the local population is largely
immune from having had the disease; various other explanations
have been offered, all more or less wnsatisfactory. (In this
connection it is interesting to note that the older authors state
that yellow fever was largely limited to foreigners when it first
appeared in Rio de Janeiro in 1849.) Immmity studies in verious
groups should aid in solving this problem.

I regret that this letter has grown to such proportions
and is so indefinite; in conclusion I would @ay that I believe that
the yellow fever problem in Brazil could be better defined had we
available reliable data from various parts of the country on the
f/f a

distribution of immunity to the disesse; I fully realise that
general studies of such distribution are extremely expensive as long
as monkeys are required for the tests but believe that the information
gained from limited studies of a few well selected communities should
be worth while. With the previous methods of study of the distrib—
ution of yellow fever, little more than the geagraphical distribution
of the disease could be ascertained and even that was frequently at
fault. An immunity survey such as we hope to get from Magé

should enable us to visualise what actually happens when yellow fever
is introduced into a small community where it has not been known

to exist for twenty years or more.

 

Although we have bled a large group at Magé, I
had never considered using more than one hundred monkeys for
this study; Dr. Beeuwkes suggested that worthwhile results might
be secured with as few as sixty animals if the cases to be studied
were chrefully chosen. We are now engaged in an analysis of the
groups from which we have bléod specimens and hope to have thoroughly
representative material to choose from; the only immediate result
of this study will be the determination of the present distribution
of immunity in Magé. I shall probably forward this material to
the Bahia laboratory in the near future but no tests will be run
until we hear from you. I would appreciate a cabled reply.

Very sincerely yours

(Signed) Fred L. Soper.
Dr. FeF. Russell, .
The Rockefeller Foundation,
61, Breadwey,
NEW YORK CITY

The Rockefeller Foundetion,
International Health Division,
61, Broadway,

NEW YORK

October 23, 192
Dear Dr. Soper:

The amount of work which I have had to do in making
our ‘book of estimates for 1930 and the necessary arrangements
for our annual meeting has prevented my replying to your let—
ter No, 1494, dated September 9, 1929, This letter is a most
interesting one. I think the study which you have planned
is one that sooner or later we should make and the way you
have outlined and advocated it is admirable. It may be a
minor objection, but it occurred to me, as you will have noted
from my cable of September 28, that since this is yellow fever
work it should be done in close cooperation with Br. Connor.

The second point is the expense involved, which is
very considerable, and our yellow fever expenses are alre:d,
high. Mr. Frobish:r has, as you know, been making studies
it

on complement fixation in yellow fever and when he left he told

me that the test was just as reliable as the Wasserman test.

His experience in New York wes of course limited. In Brazil

he can pursue his studies further on complement fixation and

in a short time, if the test works out as we hope it will, it

will be possible to make the study which you have outlined not

only in Magé, but in other towns in the north and south of Brazil.

I can see the value, as you point out in your letter, of such
studies in many places. Beoause the problem of the necessary laboratory
work of such studies is such a big one my own inclination would

be to postpone the program until such time as Frobisher is ready

to run complement fixations on an indefinite number of human bloods.
As you see, I look upon the study in Magé which you propose as
merely the beginning of a series of similar studies,

If in the meantime you have any othet ideas of such
studies I hope that you will talk them over with Connor and
will write to me. I am anxious to have the studies made
as soon as they can be done at a reasonable cost in money and
in fersonnel. I am sorry that so much time has elapsed since the
receipt of your letter, but you can well understand that press of
work has prevented me from replying earlier.

Very sincerely yours,
(Signed) F.F. Russell.

Dr. Fred.L. Soper
Caixa Postal, 49
Rio de Janeiro,
Brazil
42.

Sept. 10th, ERR arrives from BA on the Sierra Morena;repepts a good trip and

is glad he did not come on the American Legion which ran on the rocks in Monte-
video one hour before they passed her. The situation in BA appears hopeless to
ERR for the following reasons: There is a widespread antipathy to Americens in
Argentina and the present government is unwilling for any foreign organization -
to administer public services in the country; the present administration is
using. government services for patronage only and is making no restrictions as to
the preparation of individuals for government employment. More specifically,
our contract has been definitely broken by the government through the deliberate
refusal to give free entry for belongings of Dr. Rickard; There is no further
field for the type of work that the RF was doing in Argentina; the studies which
had been planned for the coming year either have already been made by the gove
or are of a type that would not justify the expense. ERR feels so keenly the
futility of going on under present conditions that he must resign from that field
if the RF decides to continue. ERR states that he returned to SA for the pur-
pose of seekhg the Argentine Service through but that now that he is convinced
that there is no future for this service, he is willing the return to the USA
and leave the Foundation or he is willing to work until the en& of his present
tour of duty and rethre on his return to the USA. He requests that I discuss his
decision with FFR when I arrive in NY/.

News arrives that there is another hospitalized case of yf. ERR and I
find a typical fourth or fifth day case fram the R. Assemblea-no history of
outside contacts other than a passeio to Santa Thereza Hill three or four days
before onset.

Visit OCI and converse at length with Aragfio.

Sept.11

Wire New York regarding Argentine situation.
Dinner and Bridge at the Dawsons.

Sept. 12.

Visit Servico Maritimo to request data on immigrants. Lacerda promises
to get the desired information and shows us through his sefvice; says his gener-
al index in March when he took over was from 27 to 355 R/s index now is very
low. His service is repponsible for twenty four islands and all the craft in the
bay and employs Sevepbygight men. ERR and I visit one of the Islands with L
in thefast Crisscraft with Chrysler engine.

Sept. 12. Receive letter from the Secretary of State of the S&kte of Rio in which
exception is taken to my interfering in his department!!!!!! Later in the day
JTA and I go with Decio and Lintz to interview the secretary regarding the placing
of the Malaria service in the Health Department. A definite proposal is made to
the Secretary and it is believed that everything will be peaceably settled.

Sept. 13. ERR embarks on Asturias for BA having been authorized by telegram
rom o close out service there. Finally secure tissues from Albina Xavier
from DNSP laboratoyy.

Case from Assembles’ died yesterday and has been confirmed.
Case in Nichteroy died this morning.

Sept. 14.
Rangell promises cards for Monday.

Sept. 15.

Sunday. WSA calls at house and gives information regarding origin
of case dying on September 12 in the Rua Assemblée. This case was undoubtedly
infected in Nietheroy. Ve reports absolutely no breeding in zone where case

fi
occurred & Vie ¢ ff
Sept. 16.

MEC arrives on "Zeelandia",.
42.2°A.

Sept. 16th. Continued. MEC in very good physical condition apparently except
for a crop of what he ealls tropical boils. Believed to be the dame thing fron
which Crawford has been suffering the past six months. Local swellings appear
deep in the tissues without fever and gradually come to the surface. Are accomp-
anied by a newrotic process but tend to heal readily after incision and removal
of the necrotic core which readily sleoghs out.

Call on CF with MEC. MEC tells CF _that he is more optimistic reparding
the yellow fever situation in the North than at any time in the past. In reply
to enquiry CF states that it will be impossible for him to make his proposed
trip to the north because of the recent appearance of cases in Rip. However,
he very definitely intends to make the trip to the Congress in Recife in October.

MEC enquires as to the dispodition of our house and furniture and suggests
that the service purchase my car but on the other hand glibly discusses my return
via Para and suggests thet he would like a vacation about May; Talks vaguely about
possibility of taking indefinite vacation at that time. Says he has not suggested
to FFR that he would like vacation.

Call on Servulo and Waldemar Antunes and meet others ofthe yf service.

MEC dines at 125 Bolivar. MEC says that FFR is thoroughly convinced of
the wisdom of having staid out of Rio this year when the oppottunity was given
as long as we could not come to the DF at the same time; I do not discuss the
matter at all. MEC decides that ERR is best placed in the Rio office especially
as he does not care to remain in the field beyond the present term of service.
MEC asks then that power of attorney be made out to ERR but that all authorities
be notified that MEC is the director ad interim during my absence! !!!

MEC and I call on Evilg and get an offhafhd valuation of six gontos on the
car.
Sept. 17. Call on Lacerda and arrange for MEC to see Maritime Sanitary Service,

Visit Manguinhos.

Sept. 18th. Mrs. EP birthday. Madame Mesquita, Schoenfeld and MEC to dinner,
MEC spends morning with Lacerda seeing the Maritime Mosquito Service.
Budgets forwarded to New York.

Sept. 19. Day at office. Janses de Mello calls and gives account of his yf ser-
Vice and other details. Dinner with Van Hook$s,.

Sept. 20. MEC spends AM visitigg ships and lighters with Lacerda. Call with
We on Arag&io and meet Penido, Ozorio and Costa Lima. Call at DNSP and make
arrangements for MEC to see service on the land. MEC does not wish to oall on
CF but I insist which turns out luckily as CF already knows all the details of
MEC's visits to the Maritime Service/ CF takes the bull by the horns and invites
MEC to visit all the zones in Rio and makes entirely different arrangements for
such visits than thos that have already been made.

Sept.21. Invitiation received to send delegate to the Congress at Recife with
expenses paid by the State. Reply that FLS, MEC, AWB, LS, PJC, DBW and NCD would
attend but that RF would pay all expenses.

Lunch with Nave at Jockey Club.

Sept. 22. sUNDAY/ PACKING/ CHURCH WITH THE TRUSTEE.

ept. - MEC begins land study with Moscoso in Copacabana.

Sept. e4 Jacarepegua suspect claimed to be malaria by Dr. Pego. MEC visits zone
of Jansen de Mello. Davis pays furniture 3#999$000. FkS pale [eee warren
Sept. 25.AA reports four suspect cases in Merity. Conférence wikh Lints, MEC and
AK. Tints invites MEC to visit yf service, says case at Merity was pneumonia,
promises acceptance of our schedule and early incorporation of personnel. Dinner
with Commander Wilson.

Sept. 26. AWB telegram regarding trip to BA by plane arrived at 11 AM; plane
arrived at about 3 PM. MEC and I visit ocr/ CC says that Costa Crug reported
his work on K's germ last night. Fund Alberto da Cunha in CC's laboratory. CC
promises to send copy of report on K's bug. K was quite able to hand le the sit-
uation, took his medicine smiling and came back with more than Costa Cruz knew how
to reply to. Present MEC to Dr. Gomes de Faria. Take coffe with Costa Lima and
Miguel Ozorio who report on further details of Costa Cruz report.
44,

Sevt. 27th. Visit Meuricio de Abreu to arrange further visits of MEC to the

Mosquito service.

Sept. 28th. Board Itanagé to see AWB who is returnigg to Bahia.MEC says he be=-
Teves it well to plan of aetting Burke go home on vacation soon transferring

Wilson to Bahia. AA permits two of his men fram up country to lunch at the nurses

dining room. Call on CF and discuss the importation charges on monkeys in Bahia.

Explain that we believe the matter is fully settled by the recent telegram of

the director da receita to the Inspector in Bahia. CF asks me to take the matter

up directly with the Inspector in Bahia without attempting to work through BB.

CF says that BB received direct call down from him and also through the governor
of the state. Four cases reported from Roca de Brejo on the line between

K6LLES: é Curvello and Diamantina. MEC attends a cocktail party at the Dawson's.

SUNDAY/ 29. PACKING all DAY.IIII!!!!

Sept. 30. Mrs. EP and Miss Morse dine together but apart from our table; MEC
invites Dr. Tomaz to dine at his table. Advise Mrs. Andrews to limit activity

in office to things connected with the service. Arrange for Miss Calasans to leave
the service. Lintz reports decree signed for the Malaria sergice. Dinner at Jack-
son's.

OCTOBER 1. Govt opens further credit of 83:000:000$000 for yf. Sail on Zeedlandia
for Bahia with Rocha Lima and his technician, Miss Seiler.

Oct. 2. Om Board. RLV ys that Hoffmann is an ex-army medico who came to Cuba
Following the Eurodean wer_and has been busy making a local reputation for him-
self publishing numerous articles on yellow fever and other things of which he

knows as little, RL insists Chet Hoffmann bas never seen + cere of yf. First
made a big noise about the pathology found in the kidney in tissues from yf
only several rs later to lay special stress on the lesion of the liver. RL
is not suppriseé that Hoffmann reproduced bis liver plate without giving due.
credit on the plate itself; RL considers the simple statement in the text that
the plate is by RL insufficient.

October 3. On Board.

October 4. Arrive in Bahia early in the morning; Davis, Burke, Shannon and Kerr
come aboarde Go to Pensao Edith; RL and technician to Pensao Harbord. Spend
most of the day at the laboratory at Montserrat. The laboratory is very well
installed in a building originally built for the manufacture of sera for the
health department. The grounds are spacious and after many difficulties have
been planted to vegetables to help feed the animals. Beside the main building
there is a gurage for two cars, an outside animal house at present devoted to
guinea pigs and an incinerator. On the ground or basement floor of the main
buildadgg is located the unused animal room; here also are to be found the main
stock room, the carpenter shop, the gas machine, and a well screened room

for guinea pig experimentation.

' On the main fhoor of the laboratory building are three main divisions,
the general roam, the mosquito room and the infected monkey room. The general
room is protected by a doubly screesed entry and the only entrance to the
mosquito room is through a doubly screened entry from this general roomy in the
center of the mosquito room is a large screened cage in which the cages contain-
ing infected mosquitoes are kept; this large cage is divided into three ocom-
partments, the first of which is the doubly screened entrance, the second is
work room where feeding experiments are carried out which is separated from
the third and larger compartment by a screen door; this third compartment is
the storeroom for the cages containing infected mosquitoes.

There is no entrance from either the general room nor from the
mosquito room to the infected monkey room.

RL visited the laboratory in the afternoon and indicated what mater-
fal he would like to have for tomorrow.
October 5. Saturdays RL and technician appear and start to work. Kerr is work-
ing on liver and kidney functional tests; if JAK had yellow fever in August it
would seem most logical to think that he had been infecte rough the handling
of fresh infecthve blood. To carry through these tests K has been taking blood
from certain animals each day after infection and has therefore undoubtedly been
handling a cebtain number of bloods at their most infective stage; in the cent-
riguging of such bloods and the separation of the sera day after day it is
possible that he came in direct contact with the virus although his work

 

 

 
45.

has been done with rubber gloves. Immunity tests with bloods of NCD AWB and

JaK are to be begun tomorrow.

Oct.6. Sunday. ALL day at the laboratory, then to Davis home where I find
Donald, Irwin, Stanley and Franklin quite grown up. Mrs. Shannon is entertaining
the children when we arrive. Burke, Kerr and Shannon come in later for dinner.
Oct. 7th. Vacant lot inspections with AWK. The yf service now has a number of
squads of four or five men each cleaning vacant lots and hillsides to prevent
breeding. The loaal regulation of the lixo serviee does not permit of the remov=
al of tin cans at the expense of the prefeitura. Therefore the yf service finds
it necessary to bury them after they have been thrown over the wall into the most
convenient vacant lot or hillside by the servants. The problem of hillsides and
vacant lots is much more difficult in Bahia than any phace I have ever been; it
is rea}ly quite surprizing the actual area of the city devoted to steep hillsides.
Bahia at present is divided into 76 zones and has a total force of some_two
Tundred end twentyfive men. How different from the staff of thirtynine wisn was
éa duty in the old optimistic days when I was here in January 19283 Killed a
steg my room at the Pensao Edith. ° as

October 8th. Lab all day.

 

October 9th. Spend morning with AWB going over details of local service and
trying to léarn how a service is organized. Burk does not believe that the
steg index of Bahia was ever very mach below what it is at the present time.
For some weeks now B has been checking the index of the GC's visit with the
guerda against the index of the guarda's visit plus the index of the GC's
visit behind the guarda. In the beginning these two indices were widely div-
ergent but lately have beeome more or less the same. AWB can give no special
point in which the service of Bahia is so difficult; both the indbor and out y
door services are difficult because of the the hillsides, the lack of water “
supply, the failure to remove tincans and the utter inability-to secure from
BB any cooperation in enforcing regulations.

NCD and I call on Inspector of the Alfandega who suggests that we get an
order from the Minister of the Fazenda to him to concede freedom from duties
on all impottations of monkeys into Bahia.

October 10th. JAK immunity test icate that he has had yf. Mosquito catching
with NCD, Shannon and at the fazenda of Dr. BBarretto.
October 11. Day at lab. Dinner with Davis and Family.

 

October 12th. Officially a holiday. Spend day at Laboratory. Davis
purchases collection of monkeys off the boat arriving from the north.

October 13th. Sunday. Morning on the beach. Afternoon at the Laboratory.

October 14th. Dr. Rocha Lime visits Control Service in the forenoon. Rest

of day at the Laboratory.

October 15th. Dr. and Mrs. Frobisher arrive on "Almanzora", Drs. Davis,
Burke and 1 join Dr. Connor for Recife.

October 16th. General discussion by our group of results of vision tests

on guardas in Bahia, also some discussion of classification of houses and

of the importance of extraneous breeding. Official dinner of Captain to
the members of the Cangress of Hygiene. Drs. Davis and Burke do not attend.
Discussion with Dr. Kontenelle regarding the School of Nurses. fF insists
that the nursing profession cannot make rapid progess in Brazil as long as
all nurses in training are required to live at the Nurses' Home. FF has
been chosen pare nlpho by this year's class and desires information regard—
ing the history of ‘nursing. States that he and FP have not been on speak—

ing terms for a year.
46.

October 17th. Arrive in Recife. Meet Drs. Doyle, Cardoso and Crawford,
ail of our Service. Official reception at the Palace in the afternoon.
Official opening of the Congress with addresses by Drs. Fraga, Amaral,
Gouveia de Barros and Professor Fialho. Dr. Fraga pays tribute to Dr.
Lewis and thanks the Foundation for its cooperation in Yellow Fever Control
on behalf of the Government.

October 18th. Visit Maritime Service with Dr. Cardoso. Dr. Cardoso
has been able to secure the right to prohibit the departure of sail boats
from Recife unless their water barrels are properly protected against
mosquitoes. Visit Ilha de Pinna and find one focus behind the guarda,
Cail on Mr. Batham\of the Great Western. Attend Congress in the after—
noon and evening. Dr. Aragéo presents latest results in Yellow Fever
Research.

October 19th. To Olinda with Dr. Doyle. One focus behind the guarda
‘and one with the guarda in thirty two houses visited. Olinda is being
worked only on Saturdays although Dr. Wilson would prefer a regular
service similar to that of the rest of Recife. Preside at Dr. Fraga's
request at part of afternoon session of the Congress. Ball at the
Government Palace. Dr. Davis does not appear, Dr. Burke appearing for
a few moments only.

 

on Dr. Guedes Ferreira who assures us that ®

o Cw ae

 

October 20th. Leave Palace at 3.50 starting to Parahyba at 4.50. 4

’ Sunday dinner with the Crawfords on the
beach. Arrive in Recife about 7 p.m. Dinner at Wilson'ts.

Ootober 21st. Luneh with the 1912 Rio de Janeiro Medical Class. Make
arrangements for Dr. Agricola, Dr. Waldomiro and Dr. Placido Barbosa to
visit our Service tomorrow. Rocha Lima presents a paper on Oroya Fever.
Attend official concert with Dr. Connor.

October 22nd. Visit Yellow Fever Service with official guests. Lunch
with Bathang and Mr. Jones. Inauguration of bust of Amaury Medeiros.
Confress Ciscussion of maleria papers very limited. Officiel closing

of the Congress with oration, gloria a ti Pernambouco by Dr. Antonio

Barros Rarreto and a counter oration by Dr. Alcides Figuereido of Nictheroy.
Farewell dance at the Jockey Club.

October 23rd. Embark on "Arlanza" for Rio.
October 24th. Dine in Bahia with Rockefeller contingent.

October 26th. Arrive in Rio.
aS

i
“3

FURTHER NOTES ON OCTOBER TRIP TO BAHIA AND RECIFE

 

Professor Abreu Fialho, present Dean of the Medical School
brings up the question once more of Foundstion assistance to the
Btetopy Institute which is being founded. Dr. Arthur Moises, it
seems, is also very much interested in this project. As @ matter
of fact he discusses it more completely than does Professor Fialho.
(Dr. Moises refuses to return to Rio by air plane because of the
impossibility of passing seventeen hours without talking.)

 

Dr. Gouvesade Barros, my Brazilian godfather, shows but little
change after the lapse of almost ten years. He has been fivins by
far the best cooperetion secured in the North. I assure him that I
expect proper treatment from my godfather to my godchild, Dr. Rickard
who is soon to go North.

Dr. Cassio Miranda of S& Luiz discusses and explains our
financial difficulties. Everything is now apparently cleared up.

Dr. Fontenelle says that he has been elected paranympho of
this yearts graduating class from the School of Nursing. He states
that he and Mrs, Parsons are not now on speaking terms. He believes
that it is because he has advocated having extern students in the
School of Nursing.

Dr. Borges Vieira says that Dr. Jayme Pereira has been attempt—
ing to arrange a fellowship for Dr. Bento Ribeiro in Sio Paulo. It
seems that Dr. Jayme has even written from the Tmited States insisting
that the fellowship is all arranged.

Dr. Afranio Amare] takes occasion to recognise me and fishes
for en invitation to visit the Yellow Fever Laboratory in Bahia.
This I cannot very well do as Dr. Arag&o has been invited to pass
some days at the Laboratory en route to Bahia after the present
Congress. BO

Dr. AeL. Barros Barreto introduced a motion supporting the

ides of # Federal Ministry of Health. Ue maintained himself on the
Executives Committee in spite of the expréss desire that the Executive
Sommittes should be changed. This action be justified as being the
unanimous desire of the entire delefation from Bahia. CF deseribes
him as infantile. He complains to CF on the eve of departure from
Recife that he has not been given a cabin de luxe om the "Arlanza"
and insists that he is the ranking personality at the Congress.
Dr. Fraga explains that the three cabins de luxe available were
assigned to Dr. Fialho, Dr. Jo&o Barros Barreto and himself and
offers his cabin to ALBB who accepts it!  AIBB avoids speaking
to me during the Congress end the return trip.

 

MEC on October 23rd states that he fecls that RF has been
pelittled at the Congress, that RF should work nowhere but where it
is duly appreciated, that motion approving CFts work with YF was
passed but no motion considering the work of the RF was considercd.
I take occasion to contest this opinion since yellow fever was not
@ subject for discussion at this Congress. It is true that Aragéo
48.

gave a paper, but this was an evening address, the same as that of
Rocha Lima's on Oroya Fever. CF paid due tribute to Dr. Lewis and
the RF in his opening address. The representative of the Found:tion
presided at one of the afternoon sessions of the Congress and sat at
the Governorts right on the evening of Dr. Rocha Limats conference.

I, for one, feel that the RF received ali the attention to be expected
MEC has asked for six months! leave without pay beginning in April
Plans on shifting Cumningham to BahiaLeboratory and has written to
FFR thet Bailey will be left in Rio de Janeiro Office.

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FUNDACAO ROCKEFELLER
Rio de Janeiro

No.1714 80th December 1929

 

Dear Dr. Russell:

On the 26th inst., I conferred with Dr. Frege, more es-
pecially as relating to our government budget for the year 1930.

Fof the year 1929 from March to December the Government
allowed us 5,000:000$000 for yellow fever work in the Northern Zone,
Of this amount we expended of less than 1;000:0008000, the exact
figures will not be available until early in January. For 1930 I
have requested the renewal of the 5,000:000$000 and Dr. Fraga has
approved of same.

During the recent graduation exercises conducted by the
School of Nursing, Dr. Fontenelle delivered an address, a paragraph
of which emphasized that the Government would not renew its contract
with the Rockefeller Foundation for financial and technical assist-
ance to the school, and further that the American nurses now here
would soon be replaced by Brazilians.

While the above statement summarizes our Divisionts policy
as regards our cooperation with the School of Nursing, the emphasis
which Dr. Fontenelle placed on the statement sas of such a nature as to
give rise to the suspicion that perhaps his discourse was inspired;
we do not have a signed agreement for the cooperation,

I conferréd with Mrs. Parsons and she thought that I should
try and ascertain from Dr. Fraga his attitude in this matter, I did so
and he denied previous knowledge of Dr. Fontenellets intentions, and
furthermore, Dr. Fraga was most emphatic in assuring me that he was
nost anxious for our Division to continue cooperating with the D.N.S.P.
in thé development of the School of Nursing. He stated that the ser-
vices of Mrs. Parsons were greatly appreciated and, while he didnot
always see eye to eye with her in administrative details, he neverthe-
less realized that the problem was complicated, at times very trying
but progress is being recorded, He is equally pleased with the ser-
vices of the other American nurses,

Dr. Fraga told me that the President would always find suf-
ficient funds for yellow fever; also that the incoming President is
pledged in favour of creating a Ministry of Health. Dr. Fraga's friends
are urging that he be appointed to this position, which he will accept
if the invitation is extended,

The occasion seemed to be opportune to approach the question
of our Division's further cooperation in Brazil, I had in mind your
frequent reference to a County Health Unit program on a large scale,
On mentioning this to Dr. Fraga he immediately replied that his in-
terest in public health matters lay first in seeking the eradication
of yellow fever from all Brad; sewond, the completion of the Sao
Sebastiao Hospital; third, that the yellow fever question definitely
settled he would like to arrange &@ cooperative program with our Di-

vision for the control of malaria in the capitals of the principal
S2

50th December 1929

states where this infection is a serious problem. I pointed
out that a program on an extensive pian such as we are now oper-
ating against yellow fever would be a tremendous undertaking
but that our Division is interested in the malarial problem and
I would submit his suggestions.

I think Dr. Fraga has in mind that our present organiza-
tion will be in a position in one or two years to lessen concen-
tration against the stegomyia and to turn to anti-malaria measures.

In several sectors, principally Bahia and Recife, we are
actually reducing the malaria incidence througt: grass cutting, ditch-
ing and sub-soil drainage work undertaken to reduce troublesome mos~
quitoes,

Very sincerely yours,
(Signed) KM. E. Connor

Dr. F. F. Russell
The Rockefeller Foundation
New York City.