FLS 1930.
J 2. Davis wires that Nair liver Vicosa Alagoas negative; this case was
autopsied by Almeida about June 18th; was young child without
typical history but living in known heavy yf focus. Almeida notified.
; Wilson wires regarding Barros Barreto account; reply that account
should be charged through the laboratory to be paid entirely by the RF.
Visit ten houses in Zone 51 with the guarda and Crawford; one
steg larcal focus found in barrel; nobody complaining of carapanas now but
several state that some time back there were many mosquitoes.

Discuss with Dr. Albino Cordeiro the possibility of autopsies in the
interior; he states that the problem wi e very difficult to solve an at he
personally believes nothing emma be accomplished except through doctors of the
health services or through doctors who also happen to be intendentes of the
counties where they live; nothing is to be expected of the tabelliaes(registrars)
as he has never even been able to secure from them reports on the total number
of deaths occurring in their districts! Then too the people of the interior are
very ignerant and are very superstitious regarding the bodies of their dead; all
in all, it is palin that he advises against the making of the aptempt to secure
livers from the interior. When Dr. Crawford and i

9 9 th 9 . A
gard a n. I come at on the fact that it
Was throu ort that we were a 8 ow fever
“Belem through routine autopsies and stress the Point that when I asked for _

Gat mapa te dori, wo hee nothing more Wane general idea that the disease |
might be here; that we had thought poss sure to discover the disease with a large
number ol autopsies over a number of months but that as a matter of Fact, the third
autopsy was positive, It is pointed out that today we are in an entirely dif-
erent situation; knowing that the disease exists in Belem, we are forced to admit
that the disease has wither hung aroud in Belem since July of 1989 or else has
been subject to exportation and importation since that time. (Of. course both
hypoteses may be true at the same time.) In any case for the future of the control
work it is important that we know how much of the disease exists in the interior
of the state. Dr. Valle gets the idea immediately and suggests that we call on

the chief of the state police in his name and ask for cooperation and suggestions
as to how sucha service can best be organized in the interior,

During this conference with the president, the question of . calhas is
ventilated quite thoroughly; EV reports that the measure is being forced through
as a municipal one which is where it should be according to the division of pre-
rogatives; he insists that the measure should have been presented to the Munétéipal
Council yesterday; the Secretary of state says thet it ic ‘o be Tronght up for
vote today.

Call on the chief of the state police who is also judge in Braganca; he
suggests that Braganca.be made one of the points of our contémplated studies as

in 1925-26 Sherakas an eee there of what he believes to have been yellow
from the details tha TS able to give from memory it would appear tha
his may have been the case. The chief says that there are really three avenues _
of approach to_the problem of getting lw ors from the interior; tS through the
tabelliaes or registrars who are responsible for registring births and dea

thelr respective districts. However burial often occurs at quite some distance
from the seat of registry and often whAl have occurred several days before being
registered; this most logical solution of the problem then which would appear th
strike the source of supply is not to be recommended. The tabell&ao also is not
directly subordinate to the administrative arm of government and would have to
be handled through the judiciary. 2@nd. Through the sergeants of the state police
who are to be found in every district; these men,however, have no direct son-
nection with the mechanism of burial except in special criminal cases and are in
many cases entirely illiterate havéng been chosen only on the bazis of their
ability to dominate their personnel and their districts. The only advantage in
using them would be that they are ubiquitous and under direct control of the
whief who is willing to help us in every way possible. rd. Thro the intend-
entes or local county administraters; the intendente in each place 18 appointed |
by the governs? as the loeal representative of the state government and is very
sensitive to the suggestions made by the state.

   
 
 

 

 

 

 

 
FLS 1930

J 2. continued. The intendente has under his direct control the adminis-

trators of the cemeteries who are generally very poorly paid and
should be willing to take a real interest in getting liver fragments for a
small premium per fragment. The chief recommends that we first $y for livers
Earough the intendentes. I accept the suggestion but insist tha e attemp
be 1 sed to one or at the most two counties until the routine can be worked
out. Dr. Albino indicates Vigia which lies between Belem and the Atlantic on the
right bank of the Amazon as a good place to start as it is accessible and is
probably the most important point of departure for the small boat trade covering
the coast north ofthe Tmazon. Actual details of organization are left for
Tutaure determination. Dr. Crawford will probably go to Vigia to arrange details
with the intendente.

 

 

Notes regarding discussion of local problems with Dr. Crawford during the last.
four. days; ;

; . Medical Vigilance. PJC has been using one of his doctors in the after
noons to check up on fis Clinical histories of reported deaths which from their
diagnoses might be thought to have beendue to yellow fever. I suggest that this
service be discontinued as soon as convenient without letting the local authorities
and our om personnel know that the discontinuance was suggested by me.

Routine autopsies. _Should not be allowed to take more time and energy
than is absolutely necessary. Liver sections are all that are needed an ese can
bo not waste Tine getting hisvories of cases before @5 of oases before

tional visits must be made to secure them. A

' of the city mig be worth Sug subordinate employee be trained
“to remove liver sections,

Fumigation. Not a part of. our programme. When pressure is brought to -
bear attention may be called to Dr. Theophilo Torres' report on the Fabrica das.
Chitas epidemic in 1907-08, the last epidemic in Cruz's time in Rio. Torres in-
sists that the direction of spread of the disease was influenced by the direction
of the prevailing winds carrying infected mosquitoes driven from infected houses
by fumigation always in the same direction. Similar relatiaénship has been claimed
for cases occurring in upper and lower cities in Behia.

Accidents to Employees. Workers injured in the line of duty may be
sent to the Assistencla Publica and treatment paid by yellow fever service. Prefer
that Dr. Crawford take no part in treatments.

Notification of Yellow Fever. The yellow fever service should always
notify local health authorities of both the state and the federation; newspaper
notifications should come from other sources. ( The two accidental confirmations
of May were notified by PJC to Dr. Albino; the governmar of the state suggested to
Albino that the cases be not reported.) Should take into due consideration the
diagnoses made by Dr. AbenAthar but should always submit specimens to Davis for
confirmation.

  
    
 

 

 

 

  
   

 

Classification of Guardas. Suggest relatively small difference be-
ween salaries of guardas of different classes; probably 220§, 240§ end 250%
would be reasonable basis; focus found behind guarda by GC to be counted against
guarda for classification only after verification by doetor or guarda chefe geral
of the service. Focus behind guarda to be counted anly if found within 356 hours
of the time of his visit.

Classification of Guarda Chefes. I fail to approve this idea. GC is
in responsible position at higher salary and is supposed to know his job. Suggest
more rigorous checks on service of guarda chefes with severe penalties for
defects in thetr service; guarda chefe not justified in leaving foci. Do not
‘classify but fire for ineificiency.

Increases in personnel. Should be made only after due authorization.

All American directors will be constantly informed of my whereabouts by telegram,
Authorization at present time is made for appointment of guarda chefe to direct
and check work of the gutter squads; for increase of office personnel to permit |
of all strictly routine work being done by subordinates, to make block indices
available on following day. Also special clerk may be hired to keep file of |

 
FLS 1930,

July 2. continued. legal notives and fines.

Distribution of Fish and Sealing of Water Boxes. As both Muench and
Crawford believe that the institution of these measures which are expensive
would not greatly better the pecal situation, it is suggested that eduaational
means be attempted to get deposits fished and water boxes sealed. Fish will
not be furnished here but are so readily available on all sides that no one
should have difficulty getting them. In the meantime, first oiling and breaking
and then fining is to be folbowed out in repeating foci,

Station Journal. Only one station journal is to be prepared in Belem.

The doctors working undér Crawford should submit to him whatever details of their
work he desires; important points in their reports or regarding their work may
be included in the station journal. The station journal should be limited to
relevant information; correspondence and telegrams need not be copied except in
so far as it is desireable to insert verbatim instructions or vital information.
It should be remembered that the station journal is a Station Journal and is
neither a personal diary nor a narrative report to the central office; any matter
requiring action or discussion by the central office may be mentioned in the
station journal incidentally but should also be called specifically to the attent-
ion of the director by special letter covering the point. The station journal is
intended specifically as a running history of the service for the future orientation
of the director on all important points for which he would atherwise be forced to
depend on memory and for the orientation of possible future directors who have no
first hand knowledge of the situation,

Sick Leave. Employees reporting sick are to be investigated by the GCG
or one of the medicos. Each case should be judged on its merits and pay continued
in judgement of local director up to maximum of two weeks.

Mother Foci and Breeding Roof Gutter Squads. When daily information on
steg indices by blocks is available, special guardas may be detailed to work dirty
blocks to discover pupal foci. A special ladder gang is to be detailed to the ex-
amination after fifteen days of all roof gutters found breeding on previous round.

Stamping of receipts for payments. Up to the present time the business
houses of Pare Rave refused 60 sign duplicate and other copies of receipts without
affixing revenue stamps to such copies. In the past two copies with stamps have
been submitted, one for the government and the other for the RF accounts. The
other copies that must be filed in various places are nothing more than the accounts
as presented and carry no notation to show when, if, and to whom paid. Suggest
that a rubber stamp be prepared carrying the declaration to be signed by the house
that a receipt for payment was signed on sugh and such a day. g

Numbering blocks. Suggested that blocks be numbered on the four egners
with arrows indicating the itinerary of the guarda and the number of the sone.

Tuy. 5. To FFR_- JunE 29 to SuzyeZ.

 

 

 

 
FLS 1950.

July 3rd. After discussion of local situation with PJC, authorised the

following ingreases personnel; office staff, 2 if necessary;
gutter gangs, one guarda chefe, one guarda, 2 serventes, ‘these squads
of 5 men each, now working on vacant lots. This number can probably be
reduced: after the first time over; one man now on ditches and 6 men in
districts 7 and 8 is one lesseach serventes working with the guarda),
mother foci squad, one guarda.

July 4th. Arranged with Dr.Albino for our men to get the keys of empty
houses at 4 p.em. one day returning same at 2 peme following
day» PJC and I visit vacant lot squads and find excess of zeal in cutting
trees and slack work in collection of water containers. Sail at midnicht

on Itapé for Rio.
July 5th. On board Itapé.

 

July 6the Spent several hours in Séo Luiz Maranhfio. Dr. CM and guarda chefe
report everything in good shape with recent emphasis on preven
tion of gutter breeding. I explain to CM result_of routine sutopsies in
Belém. He promises to secure in the near future 30 or 40 autopsies from
S&o Tuiz. HH opsies from the interior. Ha
conference with Dr. Pires Leal, Director of Prophylaxia Rural for the State
of Piauhy, with headquarters in Therezina. Dr.Leal is a brother of the
Governor of the state of Piauhy and has been bringing pressure to bear
during the past year to secure a yellow fever service for his State. TI
have promised him such « service just as soon_as he secure & positive autopsy
on yellow fever. Dr.Leal has not heard of any suspect cases in his State.
July “the On board I[tapé.

July 8th. Fortaleza, Lunched with Dr.Uchoa.. He reports local situation une

changed. SU is anxious to be relived of the responsibility of the
yellow fever service. I suggest Doyle will be able to take over about August
loth to 15th. .

July 9th. On board Itapé. ) dha. tr

July 10th. Recife. Dr.Rickard demonstrates first working model of instrument for
removi iver section. This mode ears pratica a duce
the danger of infection: ersons securing tissues and should make the operation
more acceptable to the public. ERR reports satisfaction with new forms but
suggests waiting longer before general adoption. Wire Dre Rocha requesting staten
ment of future plans.

 

   
 

July llth. On board Itepé at ( .
wy pect YF y bloga.
July 12th. Bahia. Saw convalescent suspectp»at Ape gpitelfwith Dr.Fernando

luze My impression is yellow fever. gque unningham be sent to
AracajG not later than July 15th. Secure list from laboratory of people in Magé
from whom further blood specimens are to be procured. Davis and Shannon returned
today FO gees: They believe Ilheos infected. (Tews pros)
July 13th. On board Itapé. ‘

July 14th. On board Itapé. Arrived Rio 7 pm.

July 15th. Day at office largely routine. DBW reports suspect cases in Spaniard,
~—~"—"Bahia. Probably influenza. (Later July 22nd DRY reports lung consoli-
dation), probable diagnosis influenza pneumonia. Conference with CF. Quite frank
statement to CF of difficulties of situation in North. Reported opinion regard=

ing Lheos. CF very anxious for immediate steps. I reply Wilson has been authorised
to institite control mesures there as soon as laboratory report is available,

but that IT see no reason for precipitated extension eas far os Rio de Janeiro is
concerned, because it would appear that the yellow fever virus has been present
~
Vv nt
x

ae FLS 1930
ANY a
/ ae ~

o

in Ilheos at_ least. since January, furthermore this is the least favourable

season 6f the year for development of yellow fever in Rio.

Waldemar Rocha cables resignation from yellow fever service wee

July 16th. Registered garage transfer with the police. Dr.Paranhos comes to

~~~ office and reports activities in New York.

July 17th. To Oswaldo Cruz Institute to discuss situation with Aragio. Epent
the evening with Aragio and R.Lima discussing various phases of

yellow fever work. Secure promises of white mice from both Oswaldo Cruz and

The Biological Institute in Sfio Paulo. DBW cables sugkesting Dr.Lima Netto be

relieved from service in Bahia. Release anproved with payment of one months'

salarye

July 18th. Presented report of yellow fever service for May to CF. Called on« as
S.Lima and discussed local situation with him. Call Dr.Ferreira - wee

Pinto regarding samples from Magé but learn his sisters’ illness will prevent a“

his working in the near future. Cunningham finally left for Aracaji today after

missing both boat and train. ‘

July 19th. Anderson of Standard Oil offers services of patent attorney for
a making out necessary papers on tissue instrument invented by Rickard.
' Doyle ordered to proceed to Bahia and thence to Recife immediately. Conference

with CF who approves Dr.Rodrigues Porto to Recife, Dr Joke Cesar Oliveira, Fortaleza.
Dr.Braulio Furtado luz, Rio. These men will be hired imfyediately as well as Dr.
Virgilio Oliveira and Dr.Couto Myer in Bahia recommended iby CF. Notify CF that

T shall move my headquarters to Pernambuco in the near future.

July 20th. Sunday. .

 

July 21st. Receive at Treasury Rs.17:323$978, various accounts. “ilson reports
Bio en route to Rio on Prudente de Moraese Davis reports virus from
6th mouse passage killed monkey y.f.

‘July 22nd. Lunched with Decio Parreiras, Director of yellow fever service, State

of Rio de Janefro. Authorised following statement in his report reparde

ing our results in Mag&: "Mage studies indicate more immunity than yellow fever".
Our results are not ready for publication and probably will not be for some time
yete DP calls attention to fact that yellow fever in 1928 and 1929 was limited
mostly to zone Nictheroy, Rio, Rezende, whereas 1930 yellow fever has been found

in Mage and Cantagallo to Campos zone. Admits yellow fever in following places:
Between April lst and June 30th, 1930 - S.Aleixo (Mag&), Portella, Tapera (Campos),
Itoacara and Cantagallo.in addition he states confidentially that tissues from a
positive case in the city of Campos, arrived in Nictherov today. DP and T discuss
question of precedence in organisation of routine autopsies. I sugzest he publish
report immediately so as to get ahead of my report. DP refuses to publish on own
authority. Discuss the difficulties existing between Health service in the State
of Rio and National Department of Health. However, he promises to furnish me with
“Getatls of his service and results to be included in a note in "O Saneamento".

DP states Dr.&.Luz is now working in Mage. fromises full cooperation in securing
blood specimens from Magé. DP reports that Cantegallo was diagnosed from analysis
of death certificates and entire town had been fumigated and entire larval service
organised two days before first clinically suspect case was reported &y local
physician.

Chandler liver Par& reported positive by exis ae Ayana >

 

 

Spacios Wk frst ow gr bye . P?
en hewn paie wen ts,
eM teh bh gig AI Boles = an G-
Moving he gerarda evap erations /

     

 
élo 1930

July 2énd. {continued). Call on Miridwards, nanager of the Nyrba of Brazil, and
"discuss method of securing rebates on passages. lir.udwards promises to
send recognition cards for our use. ive discuss quite frankly the possible rela-
tionship of air passenger service to the spread of yellow fever and I suggest that
the air Companies should be very much interested in the control of the disease as
quarantine measures instituted among air passengers would most certainly kill the
air passenger business. Incidentally I suggested that the cost of passages for men
in our service should be further reduced.

duly 23rde At my request Dr.Henrique aragao cane to the office for a discussion of
~~" a special yellow fever cormission suggested by Dr.Cornor to study the
yellow fever situation in the North and make reconmendations. This cozmission was
to have been appointed by br Fraga at Dr.Connor's Suggestion and HA reports it
would probably have been composed of Dr.ialdemiro de Oliveira of Sa Paulo,Dr.Thomaz
Alves and himself, with probably two other as yet undétermined members. HA and I
discuss quite frankly the pessible utility of such a commission. HA sees no pos=
sibitily of the report of such a commission influencing the betterment of water
supply systems in the North. Under present economic conditions the Federal Govern-
ment will be unable to assist in bettering local water supplies even if such a
measure were possible politically.

I point out to HA that we actually have at present four organisations
operating in what may be considered possibly permanent ic @reas, namely the

D.N.S.P. in the Federal District, the Frophylexia Rural in the State of Rio de
Janeiro, the Prophylaxia Rural in the State of Minas Geraes and the Yellow Fever
Service of the Kockefeller Foundation in North Brazile Furthermore it would
appear that the State of kspirito santo, lying between the states of Bahia and Rio
de Janeiro, is without any regularly organised Service. fhe only possible benefit
I can see for such a commission might come from the Co.mission's development of

a programme for really united control of the yellow fever problem. In order to
secure such a result however, in the existing political conditions, the Commission
would have to be endowed with more authority than could be possible if organised !
and appointed by Dr.Frega. Nothing less than a congressional or presidential i
Commission could give the desired results. The appointment of a commission as was 5
suggested would probably lead to a report full of recommendations regarding methods |
of control which might very easily serve as a basis for unnecessary criticism of 5
existing services. I tell Dr.H.A. that I shall discuss the Commission frankly with }

Dr.Frega in case Dr.Fraga vrings up the subject but that otherwise I shall not push (
the matter. /

et

i

Hi believes Fraga will take an interest in case he continues with the
Health service umder the new Government in Novenber, mainly in yellow fever and an
Institute of Hygiene to be established in Kio de Janeiro.

HA hopes to work with mice in the laboratory in Rio3 has no desire to
do epidemiological surveys in North Brazil.

Rickard reports suspect autopsy Correntes, Pernambuco.

Doyle left Sew aracaju 22nd. July. Cunningham's request for special
guarda for intimation service, referred to wilson.

July 24th. Cunningham reports guarda attacked with resulting laceration of scalp,
while on duty. I cable Governor iianoel Dantas requesting necessary support.

RO plein fabllouetoS pony ie

Doyle sails for Pernambuco.

Discussion of yellow fever epidemiology with DrssLessaand Jansen. I point
out importance of recent findings in State of Kio de Janeiro and North Brazil and
FLS 1950,

 

stress importance of routine liver examinations.

word received of death of br.Theodore B.eHayne from yellow fever, at
lagos with onset 11 days after inoculation of immune sera. ©

o

New York office advised regarding Budget needs for 1930.

July 25th. Bi#o arrived in Rio from field trip investigating Séo Franscisco River

zone,State of Bahiae He collected bloods for the laboratory from
several points; found nothing suspicious in zone and secured no histories of
suspicious cases with the exception of two cases in Barra occurring in 1925 or
1926.6

Bigo and I visit Oswaldo Cruz Institute and arrange for necessary
sterile supplies for collection of bloods in hiagé and also arrange for more white
mice to be shipped to Bahia laboratory. Called on Fraga and bidéo reports on Séo
Francisco trip. CF promises to arrange for exhibition of ‘the new yellow fever film
prepared under the suspices of the Health Department for my benefit. CF agrees to
come to our office on Tuesday,July 29th for a more complete discussion of the yellow
fever problem than is possible in his office.

Learn from confidential sources of suspect case from Nictheroy in
Hospital (case visited July 26th3 somewhat jaundiced with positive diagnosis
malaria. another suspect cuse died yesterday; autopsy diagnosis pyelonephritis.)

The Governor of sergipe cables aggressor fined 500%000 by State pe eey
Health service and faces further prosecution criminal courts.

/ Fraga on learning of death of Dr.Hayne in Africa, suggests Foundation
use Drazilian personnel from endemic areas.
IN amatuer: 7
July <6tp. Dr.Ferreira, professor of hygiene, kedical School in hictheroy spends
morning at office

Bidéo and I secure material for lagé from Institute.
July 27the Sunday. Bido and I spend day at Magé$ secure 15 bloods for repeat

examination by laboratory. Biéio will continue this work alone af'ter
today.
FLS 1930.

_ July 28th. The politics] situation is somewhat complicated by the assasination (July _
26th) of Dr.Jo&o Pessoa, the President of the State of Parahyba and the

vice-President of the opposition in the recent national election of March first. Redife

where the assasination occurred and Parahyba are both reported to be in a turmoil.

July 29th. Attended funeral of the sister of Dr.Ferreira Pinto.
Dr.Ernesto Paranhos discusses Mayo fellowships.
The recent suspeot case designated for want of better information = 4s
"“correntes X" came to the notice of the Public Health authorities through a police
request for autopsy. Death had been so sudden and unexpected that poison was suspect=
ed. (this case positive NCD). Correntes is in Pernambuco epidemic zone. -
As arranged last week Dr.Fraga came to the office today for a discussion
of the yellow fever programme in North Brazil. I outlined for him the programme approv=

ed by Dr.Bawyer; I stressed particularly the value and necd of generalised autopsies
throughout the yellow fever area. CF agreed to issue_special decree or authorisation

to Be dravm up by us to facilitate working with local authorities in the North if
difficulties should arise regarding autopsies. CF requests another copy of anmal
report for 1929 alleging that previous copy submitted by Dr.Connor has disappeared from

his files. TI notify Dr.Fraga definitely that I expect to transfer my headquarters to
Recifee

 

Brought up question of Commission suggested by DreConnor for discussion
which was very brief. CF agrees with me that there is no occasion for such a Commission
at the present time.

Rickard advises of delay in Doyle's transfer to Yarahyba due to unsettled
political situation.

July Z3O0the Drawings of new instrument due to arrive today, were not received.

Wired Dr.Cunningham that only financial matters to be taken up directly
with this office; everything else to be referred to Dr.Wilson in Bahia.

Circular cable sent advising 411 posts of my proposed trip to Recife August
4the

Box of 70 white mice received today from Rocha Lima in S&o Paulo which I
shall take to Bahia for Davis.

July Zlst. lunched with Dr.Thompson Motta, Director of the Assistencia Hospitalar.
Lunch given in honour of Dre CeCeBurlingane of the New York Medical Center,
who has been to Uruguay at the invitation of the Uruguayan Government to advise regard=
ing their medical center. Dr.Burlingame was particularly interested in what has been
done in Brazil in the development of the nursing profession.
SU advises Dr.Jodo Cesar sailing for Kecife August 4th. from Fortaleza.
Wired Dr.eRocha suggesting he await me in Recife.
Suspect case reported from ParA; JeKislanov, recovered. “No albuminuria.

August lst. MreRobinson, of the Brazilian Land and Cattle Company, called and reported
much mal de cadeiras at Miranda. Requested further information regarding
the use of Tryparsamide.

Information received Parahyba service has been unavoidably suspended be»
cause of excitment due to recent assasination of Pesso&e

Dr.Rickard cables liver instrument gave good results on recent cadavers
Poor results on 18 hour cadaver. Decio Parreiras sent me drawing of liver punch dated
July 12th marked "cliché para O Saneamento". AA advises however, that such punch has
never been constructed; that today he overheard orders being given for construction by
lutz,Ferrando of liver punch along lines of kickard model described by me to Dr, Decio
on July cende

Rickard's drawing not yet received. Am wiring today for duplicates.

AL reports payments will surely be made within next 15 days. I refuse,how-
ever, to leave signed check to facilitate the payment during me absences AA reports he-
has heen made director of the yellow fever service for the first district in Nictheroy
without increase of salary.

 
FLS 1930,
August 2. Letter written to DP asking for working model of his liver punch since
he_submitted with the drawings no notes regarding results obtained with
its also stating officially to him that Dr. Rickard had developed an efficient punch,
ERR reports that three perfect liver sections were taken fram three
afeterent cadavers in a total elapsed time of seven minutes.
Drive to Institute to secure another seventy,mrather fifty, mice to be
taken to Davis in Bahia. This makes a total of 120 available including those recerved

from Rocha Lima this week.
Aragio transmits Chagas’ request for used monkeys for other laboratory

 

experiments.

August 5. Sunday. All day at the office. Translation of WAS letter for Fraga and
quarterly yellow fever report.

August 4th. Telegram from ERR announces drawings are to arrive on Arlenzat Arlanza
arrives at & am and by dint of 'special influence! the drawings are secured
from the postoffice at Spm; hurried consultation with Humpstone and Anderson and
lawyer of Standard Oil¢ appr psateon for patent will _ be made tomorrow in name of Dr.
J. Tomaz Alves, since I shall no e herd to sign necessary papers.
Meet Captain Yancey of the USA to Italy flight.
Consuitation with Shobinger regarding gutter construction on the large
-new shops of the Light company in Rio. Estimates oroposed alterations will cost about
one thousand dollars.
Bidée reports securing only forty more bloods during the week; however,
this may not be so bad since the group to be bled in Magé is now limited whereas last
year we were bleeding everyone. Gave him additional list of subjects to be bled and
arranged for more sterile material from Manguinhos.
Woman physician from school hygiene section of S&o Paulo requests
RF fellowship; would be satisfied if RF would pay passage money as present sulary
could be continued from Health Service. Promise to discuss herecase with Dr. W. de
Oliveira although she knows the fellowship service is already showing a deficit.
PandAmerican Airways Company's representative calls all worked up
over a cable received from Miami ordering to-day's plane leaving Rio tomorrow not
to touch in Par& because of yellow fever epidemic there; discuss cuite frankly the
actual situation in Par& and give him statement that no cases of yf have been con-
firmed for Par& since the 21st of June; wire PJC to give similar statement on
arrival of plane in Belém. I take advantage of the moment to impress upon this
representative the importance of yellow fever control to the air transportation ca
companies who have only one product to sell, viz., speed; five or six day guaran-
tines would of course spoil everything for them. Suggest that Pandmerican planes
be available for my travel even though they are not yet carrying pustengers.
Before embarking on the Itapagé (Capiten Parry) at 4 PM, canplete

translation of WAS letter and aut decree for signature of Fraga,
Dr. Braulio Luz arrfved Bahia July aot ,

quest Sth. On board Itapage.
EUS Meet Dr. Guimaraes, State Superintendent of Public Instruction State of

Bahia. Speaks English knows the US and should be of assistance in giving
information regarding the interior of the state of Bahia.

August 7thé Met by Wilson, Davis and Shannon. Call on Frobisher who is having his

third or fourth attack of'yellow fever'; Davis refuses to take these
attacks seriously anymore. Onset Sunday August grd, with very definite headache and
body ache some fever and possibly some disparity between temperature and pulse;
slight albuminuria on third day and slight icteric tinge to sclera today. Feels
quite weak and listless. . ,

Delivered to NCD following material; 70 mice from So Paulo, 50 mice
from Rio, one box of sera Brom the fan Francisco trip of Bido with included list and
one box of sera from Magé with list.

NCD reports that the previous batch of mice brought from the Institute
were infected with mouse typhoid and that this mouse typhoid is capable of simulating
the pathological picture of yellow fever in mice including black vomit; in attempts
to filter out the offending organksm from preparations of mouse brains it appears
that the virus has been lost after the twelfth passage; NCD suggests that time can be
saved secure mouse strains from NY; following wire sent," ROCKFOUND RIO SEND NIGHT
LETTER NEW YORK QUOTE SEND DRIED INFECTED MOUSE BRAINS SOPER {"

NCD reports Description of Male Genitalia of A. minor sent for
Departamento 8.Publica. 11.8.30

ly ,
COPIA Selle

AS ATORIDADES SANITARIAS, AOS CLINICOS E AS POPULAGOES DO

 

NORTE DO BRAZIL

Recentes experiencias em differentes localidades do norte e

sul do Brazil tém demonstrado a necessidade de autopsias systematicas nas

 

regioes endemicas ou suspeitadas endemicas de febre amarella, com o proposito /
de descobrir a presenca de casos dissimulados desta doenga. a
- . : . s 2
Aconselho calorosamente as autoridades sanitarias, aos clini-

cos e a todos que se interessam nele extinccao da febre amarella no Erasil,

que promovam e facilitem autopsias em cadaveres de pessoas que tenham falle-
ne we, ma ~ Fa “ woe wn. —

age ne ag 2

 

 

cido com menos de dez dias de doenga sem assistencia medica, e com symptomas
wee TN nt

Te
febris. H uma medida de meximea relevancia que a actual admin‘stragao sani-

taria nacional deseja facilitada por todos cne de quelover modo possam con~

ecorrer pare tao natriotico objectivo.

Rio, 11 de Agosto de 1930.

(assigne)  Clenen

tino Fraga

  

 

Direetor Geral do
Departamento Uecional de S.Publica.
FLS 1930,

sugust 7th. Continued. publication at least one year aro. I therefore wire
. Dr, Costa Lima to that effects Description male genitalia A. minor
nas already been submitted for publication.
NCD reports serum of Tobias Printsak of Natal failed to protect monkey.
This case was seen by Drs. Sawyer. and Connor in June and considered quite suspicious!
Long incubation periods of apparently thirty days have been recently enccun~
tered by NCD in monkeys in the laboratory. He believes that all possibility of cross
infection can be ruled outs; NCD was until quite recently very sceptical regarding such
long incubation periods but is not convinced that they do occur at least in monkeys.
Such lengthened periods are not necessarily associated with mildness of the strain as
one animal at least died suddenly and unexpectedly on the thirtieth day with tynical
lesions of yellow fever.

Discuss question of NCD'S and DBW's leaves due next year; assure both of
them that everything possible will be done to let them go on schedule time and that
the general policy is to get all personnel on leave from this field when due.

Inguire of NCD policy regarding the disposal ~f uded monkeys; none age
being allowed to leave the laboratory alive excepting a few that have been ceded go
otherscientific institutions for specific studies. He agrees to ship a dozen rhesus
to Chagas at Manguinhos as soon as available.

Davis, Shannon and Wilson are requested to always suimmit expense accounts
promptlyshotbe in my hands not later than the end of the follewing month,

Learn that contrary to Davis publication he has since been able to secure
transmission with a small percentage of taeniorhynchus; this brings up the problem of
their control especially in Aracaju and Maceio.

SHANNON TRIP TO AMAZON. NCD brings up Shannon trip for discussion; Shannon
called in and following details learned; MEC submitted Shannon's proposals to FFR and
the "Amazon trip" was approved whereas the “AMAZON MOSQUITO STATION" was left for future
consideration; according to the copy shown me of the proposal to FPR the Amazon trip
provided for leaving the laboratory in October with arrival in New York about the first
of January which would meen a period of three months maximum including travel time from
Bahia to New York. As the proposed trip has been altered because of changes in the per=
sonal plans of Shannon, I suggest that a more definitely detailed plan be submitted to
FFR for approval. After discussion with NCD and RS the following was outlined as a
reasonable estimate of the vrovosed trip;

Shannon to leave Bahia about Sept. 15th, to
spend five days at Fortaleza, five days at SHo Luiz, five days at Therezinha, thirty
days at Iquitos, fifteen days at Manaos, seven days at Obidos, seven at Santarem,
seven at Prainha, seven at Breves, thirty days at Belem, returning from Belem to Bahia.

In addition approximately fifty seven days will be needdd for travéea on the round trip,
so that a total elapsed time of one hundred eightyfimw days may be estimated for the
trip. In other words Shannon would be away from the laboratory fron Sept. 15th to
March 20th, Shannon states that present indications are that the government service
(Bureau of Entomology) to which he is attached will require his services July ist 1931.

NYRBA COURTESY CARDS delivered to Wilson, Davis, Shannon, Frobisher, Car-

' doso and left with DBW Cunninghems.

MATERIAL FOR ALBB sent by HAragé&o given to DBW;card left for ALBB,

ARACAJU situation discussed with DBW; advise him to visit Cunningham as
s00n as possible

FUTURE EXTENSION OF BAHIA SERVICE discussed with DBW; Advised to begin
freeing himself from the detail work on city of Bahia service; should become familiar
with population distribution and with methods of transportation throughout the state;
should look up records of previous work of yellow fever service in the interior; increase
in number of apprentice guardas authorized lookins to the training of mn for the interior.
Calha work should be continued as at present; turma de matt- rang may continue as at
present as the present squat keeps the truck constantly busy.

GENERAL PROGRAMME FOR NORTH as outlined in WAS letter of JULY 3 ra
discussed with DBWwi Promise to return as soon as possible for a thopnough inspection of
the Bahia service.

DBW states that ALBB is anxious that our central office be located in
Bahia and assures me that office quarters would be immediately at our disposal in the
Secretaria de Saude. I explain that for the present phase of the campaign, Recife is
a better locetion but that after the period of intense development there is over, it
may prove best to com: to Bahia.
FLS 1930.

August 7th. continued second. PARAHYBA DANGER mentioned by DBW; I point out that

this danger has been duly recognized for same time but that conditions
have been such that even definite information regarding the situation has been diffic-
ult to secure and that last week our service was forced to close temporarily in the

capital city because of the local disturbance due to the assassination of the president
of the state. The Federal Government is now coming into the picture and is concentrat-
ing tyoops at the frontiers of Parahyba in both Rio Grande do Norte and Pernambuco.
ALMEIDA WIRES SUSPECT YF PINDOBA three leacuee from Vicosa; to investigate
and advise me Recife ninth.

FFR wires “why is BATENE necessary} answer via Rio, " Patent advisable to (ly
prevent patent by outsiders and consequent payment of royalties by us." ,

Rio, 6. “Aqui esteve Doutor Pereira Souza representante PANAMERICAN AIRWAYS
dizendo sua carta a esta companhia sobre ultimos casos febre amatelle Para nfo satisfaz
inteiramente fim desejado e vede um telegramma seu directo a service saude Americano e
esclarecendo situacio sanitaria Par& de que depende passagem avioes ali ponto pego
resposta sua decisio ponto Alves." ,
Replied as follows, “Rockfound Bio. Following
cable sent to Crawford today quote Please inform American consul exact known status yel-
low fever in Belem stop PANAMERICAN AIRWAYS have received orders to drop Belem fran
itinerary because of ruling United States Public Health Service stop Contrary to my
previous instructions your statement of health conditions Para should be made to
American Consul and to local Health officials and not to the Panamerican comvnany stop
Can consul advise USPHS telesraphically of present conditions. Sover."

AUGUST 8, REVOLUTION in RIO GRANDE DO SUL Reported in Wireless messaze received on
board Itapagé.
FLS 1930,
August 9. Arrived Recife. Alarming news regarding urrising in Rio Grande do Sul not
——"" confirmed. Met by ERR{ Drs. Doyle and Rocha arrive from Parahyba the former
enroute to Fortaleza, the latter enroute to S&o Paulo, both sailing this evening. In-
vited both to lunch but Rochh had previous engagement.

WRocha leaving our service at the present time because of family complic-~
ations in S&o Paulo; he hopes to reenter our service later but I make no promises, His
return vassage to Rio is being paid by the service but should he return to work in the
north, return passage must be paid by him. Rocha's work has I believe been satisfactory
although Doyle insists that the service in Parahyba was so good when he left it that
it would run itself. During the recent disturbances in Parahyba over the assassination
of Pessoa, the service was closed during an entire week; the following week Doyle ex-
amined personally a large number of houses end found almost no stegomyia breeding. Rocha
is stopping off in Bahia where Davis can show him how to prepare sera for the laboratory;
R has promised to tala one hundred venules with him from Rio to Piricicaba, in the inter-
ior of S80 Paulo and secure non-immune bloods for control studies in the Bahia lab.

I wire Davis of this plan and wire Rio to pay Rocha fifteen days salary and
three hundred thirty five mitreis travel.

Doyle reports that everything is going all right in Parahyba but that he
does not have a lot of confidence in Dr. Porto who has just taken over. Wire Uchoa
that Doyle will be in Fortaleza on the llth. Doyle was instructed to take over service
as is and make no changes before my next visit to the north beyond increasing the number
of puardas in trainings Doyle knows that extensions into the interior are planned for
fhe near future.

ERR reports that INSTRUMENT is great success.
ERR and I call on Dr. Gouveia de Barros at his home. Sick.
Call on General Motors regarding car for Bahia.
Aug. '8, LIVER JOAO JUSTINO OF NATAL NEGATIVE LIVERS ADRIANO RAMOS SILVA AND THEREZA
CONGEICAO OF PARA NEGATIVE YELLOW FEVER STOP SERUM TOBIAS PRINTSAK OF NATAL
FAILED TO PROTECT MONKEY/DAVIS.
Advised Tavares of Natal results.
Aug.9. Estive hontem povoado Pindoba situado limite municipios Vi¢gosa and Anadiaponto.
Then describes in portuguese illness with jaundice, anuria and hemorrhages
which began in May; two fatal cases in July, one in June. Convalescents are
ictericjno recent cases seen, PINDOBA has about 400 housesg service organized.

Almeida. (State of Alagoas) /

This is undoubtedly extension of Vicosa epidemic.

August 10. SUNDAY ERR and I go to hospital where he demonstrates the delicate art of
snagzing out liver sections without touching the body or the sections and with

only the liver vunch of his invention, FFR cable disapproving patent received shortly
afterwards.

August 11. Following telegrams received:

’ AMERICAN CONSUL ADVISED USPHS telegraphically
today that last confirmed ease yellow fever was June 21 stop Crawford. (I forwarded
this to Rio to be transmitted to the Panamerican Airways rpveresentative. FLS)

DOCTOR VIRGILIO OLIVEIRA commenced work toda
Monday stop ee NEED MORE TRANSPORTATION FACILITIES stop Wilson. (This is cand
idate recommended by Dr. Fraga. To meet need f ati
made here through we rate im fon, ee or more transportation purchase was

S Motors of new Chevrolet touring car delivered in
Bahia at 4:509$000 or $462.00 at present rate of exchenge. Car 1929 model.)

I wired Wilson and Cunningham that FINANCIAL REPORTS of Aracaju should in
the future be forwarded to Wilson in Bahia rather than to Rio direct.

Wired Alves not to discontinue patent process as yet.

Personal telegram from Doyle's father forwarded to Fortaleza.

Advised Cunningham of arrival of American foresters in Para.

Wired Crawfophanegarding need of more automobile transportation for Par&é;

I feel we should get sufficient @ars for the immediate future.

Write FFR proposing autopsy program on large scale.

all_on Dr. Gouveia who shows telegram from RNNEBALLcBREIBBotbaBSTACIO COIMBRA
saying that GEDRO LAGO) requests intervention with Dr. Sonper to secure nomination of Dr
Bessa Oliveirafte-@ post in the Yellow Fever Service in Par&, "

at above price

  
 

Recife, Pernaabueo, Brazil,
Aveust 11, 1950,
Dear Dr. ®urcell:

One of the greatest difficulties in combating yellow fever in Brazil
is that much of the time we do not know where the disease exists end et no tine do
we know its extent; in tho absence of such knowledye we have only crude empirical ideas
as to where and for how long expensive control measures should be carried out.

 

Until two yoars azo we were dependent on the notification of suspect
cases with confirmation by autopsy for information as to the locatio “i yellow fever.
Tach notification in endemio areas having slight movement of foreigmers is notoriously |
deficient; when notified, autopsies often could not be secured beesuce of lente arrival
of health outhorities and in the absonce of epidemic conditions corteinty of diamosis
eould not be established.

 

 

A prcoat advance was nade with the demonstretion that “. rhesus is
sguscentible to yellow fever and during the past two years in Brasil yellow fever has
been proven to exist in waricug localities by the infeotion of monkeys with blood from
early suspect cases and by the demonstration of protection properties or the blood of
convalescent suspect cases. Monkeys are expensive and to secure infection from early
cares must be avilable close by; best results in the deronstration of orctection prop-
erties are secured whon the blood is drown sove thirty days after onset entalliar a
total delay of six to eicht weeks fran onset to confirmation of Cissmosie by the lab-
oratory.

More recently atudics havs teen underteken both in Brozil and West
Aftice on the distribution of immmity in different age sroups through routine pro~
tection and camplement fixation teste of represontative sampics of pomulation of the
places studied; very intcresting results have beon obtained and vlens have been made
for extending euch studies *m Brazil for the vurpose of outlining endemic zones. The
distribation of immunity even when correlated with age ond probeble time of atiack (as
Ray posetbly be done in the future throurh comparison of resulte obtained by protection
and complement fixation tests) cen st best give only the provious distribution of the
disease in space and time; the application of the remalts obtained to tho immediate
problens of the control progrem is not so clear. Thus a hich percenterse of immunity
in a place may be interpreted to mean thet the place is burned out and hence not dang-
erous; on the other hand it might be interproted to mean that because of locetion or
special local conditions the plese is subject to constent reinfection in which case
permanent control measures should ve undertaken.

 

The defects in the obove methods of learning where yellow fever ex~-
4ste from the ssimdpoint of the controlservice- are dependence of notifioation of sus-
pect cases and failure to furnish up to the minute results. Recently, routine autopsies
of fever cases with fatal termination have been made in Belém, Netoal, and-in-the-State.,
of Rid as Jaelroy in Bete the-extstence of yellow fever was proven at two widely
separated points within the control area a month before the declaration of a single
suspect clinical case at enother point; in Natal, where molaria has becn enidesic and
certain cases have closely simulated yellow fever, « rather larse nucber of routine
autopsies over three months has failed to roveal yellow fever; in the State of Rio
routine eutoosies have revealed yellow fever in districts thurcht to be clean and in

which no suspect cases hed been notified.» ;
asr yon the standpoint of the cont
hoieedl autonetes have already demonstrated that a controlled eity without visivie gel-
led cine in  . vee enraanhaateampia baba on virus of tho discase » that enother control-
: ¥ : s as to fr om fran the diso 5 tat
thak a district without control measures was urpontly in need of theat cteen me /

Differont methods havo been used to obtain ai
different placost iun Belém autonsics heve boen nerformed: be soe merely rene
2s FFRe auguet 11,1939.

to the morgue to avoid autopsies at the hane; in Ketel, tho Yellow Fever Service has
been paying o monthly subsidy to one of the health departnent omployees, not a physician
to perform oll indioated autopsies; in the Stave of tio de deneiro, the Yellow Fever
Service has trained local rogistrare to perform autopsies and secure the necessary
¢iacues with good miccess,

the Yellow Fever Service which pays the police departmont for transporting the cadavers

Although negative results cannct be considered final, the value of a large number
of routine autopsies on fever cases terminating fatally within ten days of tuset, scat~-
tered widely over the infectible area of Brazil over a period of months or years can

be overestimated in working out the details of the yollow fever problem, Follcw+

ing the visit to W ohteroy in June when I sew sevon liver specimens forwarded in qe
day by registrars fran anterior, 1 became convinced of the practicabi lit, of scours

ng such specimens without the expense of ample
fa especially im: as with the the service
throughout the endemic ereas, our interest will be contimially

 

      
  
   

  
  
  

 

        
     

extension 6

shifting to + nallor
places whore physicians are noneoxistent and where transportation 1a oftentimes poor.
For testing the method in the north, the State of Pernemouco was chosen and on June S6th
Dr, Rickard and I arrenrod with Dr, Gouvela de Barros to have the local rogistrare fran
the nine dictricts in the oounty of Nasareth called to Recife for training, inetructions
and instruments. Cn further investigntian, the supposedly nine recistrars proved to
exist as only two who would be unable to maintain the close contact with all parts of
the ooumty needed for our gurpcses,. Dr. Gouyela tnen surpostod that each locality will
have to be studied separately to detennine who oan best represent tho service. In tho

vine certain soruples arainst permitting seni~trainod incividuals

; denperoua material, was working on an instrumont designed to remove
aeetions of liver without the neseasity of cutting open the body with tho sonlpel, I sow |
the original working model on July 10th enroute to Rio and yesterday Dr. Riokerd geve mo
a demonstration on the cadaver with food results. Tho instriuent has boon used on some
fifteen cadavers; unsatisfactory results havo boon secured only in bodies long dead in
which postmortan changes had partially Liquified the liver.

 
 
 

 

 

 

Tho inetriment is so designed that the piece of livor can be secured rithout tho

- gperatep having to touch the ondaver; thore ie no occasion for rubber gloves as infective
material does net oaao in contact with the hendeg~the inatrunont is simple consisting of

but dwo pieces and is self-sufficient, ne other instrument such as esonipel, forceps nor

seissors boing used; the operation is rapid ordinarily not requiring more than thirty

seconds (Ur, Ricknrd removed liver aections fran throe cadavers within coven minutes

after entering the morsue including the time required by the omployves to remove tho

bodies fran tho boxes); the puncture 4s intercostal, the wound is mall and neatly cov

ered by the skin flap, no suture nor other special closing being required. The operation

de so simple ond rapid that sape@lally troined personnel is not required; liver sections |

can readily be secured in the hanes without great objections fran tho family of the
deceased « .

With the development of thie instrument, I believe wo aro in a position to go

ahead with an extensivwo program of Liver examinations in Forth Brazil; the results

should be much more rapidly availeble and of more value for tho immodiate future than

those to be obtained throush studies of dmmunity distribution, Meany cetoils renin to

be worked out but I have alroady been assured of approvnl by the federal health sorvico

and four governors of north Brazil heave pranised their aUpirore »

IT have zone into this matter somewhat at lenrth as I feel that, if undertaken,

4% will absorb eonsiderable time end money, I would ay oreciate your ayprovel of the

wuidertiakine before soing further.

Very Sincerely Yours,
Fred L, Sover.
- Fld vCal

Reoife, Pernambuco, Brasil,
August 12th, 1930.

 

Dear Dr. Russells

Your sable, “Patent éisapproved" has been forwarded to me here.
I have been advised that the instrument should be patented, not with the idea of
preventing others from manufacturing and using the aene but to protect cur om
freedoa in ite use. It has been suggested thet the patent be taken out and then
allowed to lepee in which case it would be cpem te all. If the program outlined
in my letter of yesterday is approved, we will be requiring a large munber of these
instruments, in which case even a aaall royalty would fer exceed the cost of taking
eut the patent. As you will notice in my diary of aug. 1 and 2nd, a rivel instruxent
is being developed, which would surely be patented for profit were it successful,
omd might be wafficiently simfiler to curs to oquse trouble later. I left Rio for
the nerth on Aug. 4th, after making arranzenents for the patent to be taken out in
the name of Dr. J. Tomasz Alves; the apvlication had been submitted and same ten
dollars spent on stanps, etc., before your first cable of enquiry reached the Rio
office. 1 believe that under local conditions the patent is sufficiently important -
that I am not withdrawing the application at thie time but chal wait until I return
to Ric and have an opportunity to learn the reasons for disapproval; I hardly suppose
it le because of the eost but presune it is against the general policy of the Found-
ation to appear in the role of commeroialising any new developments,

Very Sineerely Tours,

Fred L. Soper,
Recife, Pernambuce.
Aucust Leth, 194u.
Dear Mr, Russell:

In Bahia last week Dr. Davis brought up the question of Shannon's
trip to the Amazan walley for discussion; I was shown correspondence between Shannon
and @onnor and learned that the matter had been referred to you for approval at the
time that Shannon's scheme for a apecial mosquito laboratory in the Amazon Valley
was submitted. Your approval was siven however on the basis of Shannon's proposal
toe make the trin enroute fron Bahia to the United States, with scheduled departure
from Bahia in October end errival in New York before the first of Jonuary. As Shannon's
plens have chonred somewhat in the meantime, T have refused to authorize without
first submittine the whole question to yo: asain. The prerent plan is es follows:

Leave Bohin, Sept. Lith. Scheduled stops, Fortalesa Sdays, Sfio Luiz 5 days,
Therezinha 6 days, Iquitos 30 deys, Manacos 15 days, Obidos 7 days, Santarem 7 days,
Prainhe 7 days, Breves 7 daye, Pari 30 days, returning then to Bahia, I calculate
thet arrival in Behia with the above schedule asnnot antedate March 20th ond might
be somewhat later secording to the commections that oan be made by beat from the
various points in the Amazon Valley.

Dr. Sawyer in discussing with Shannon the details of the trip sugsested that he Pus

 

’

Lo
might be able te secure bllod specinens for inrnmolory distribution from the various ee
ne ella ’
places visited; Shannon has now euscested that we send a Brazilian doctor with hin

 

 

 

toa collect the bloods. I have told him this would be impossible.

 

 

 

The above trip will enteil the absence fran the Laboratory of at least six months
and the working up of the material secured on the trip will naturaliy require several
more. Shannon estates that his present undorstanding ié that the Bureau of Entonolosy
expects him to return to his post there July Bet next year.

fhe discussion of this proposed trip brings up the whole question of the relation-
ship of the leboratory to the sontrol service{ Had the trip remained within the bounds
previously :oproved by you, I should have offered no oppesition; since the time involved
has been doubled I feel you should be consulted. Sane dey of course wo shali have to
investigate the Amazon thepoughly but I feel we have not exhausted the entonologieal
possibilities of the actual sone of operntions. For oxminls we kao very little about
Tacniorhynchus although it is a tremendous breeder in some places during the rainy
season and has been found capable of bite transmission recontly by Davis.

(| plea AY fos
Aedes Mosquitoes of Sho Salvador, Bahia

 

May — 1950.

fransmits Yellow Fever

 

le Aedes (Ste gomyia) aegypti (Linnaeus) ¥es
260 Aedes (Ochlerotatus) scapularis (Rondani) Yes.
Be Aedes (Oshlerotetus) sermtus (Theobald) Yes\ Feeding exptse incon—
clusive. Injection of
4. Aedes (Finlaya) oswaldi (Gordon & Evans) Yes emuteitied mosquitoes
5e Aedes (faeniorhynchus) taeniorhynchus (Wiedemann) Yes (In small % of expts
be Aedes (Ochlerotatus) hastatus (Dyar) No (Adults refused to feed on
monkeys )
Te Aedes (Howardina) fulvithorax (Luts) No ( Negative to date, but
numbers inddequate
8e Aedes (Ochlerotatus) fulvus (Wiedemann) No Wo experiments
96 Aedes (Taeniorhynchus) fluviatilis (Lutz) Yese Readily infect.
10. Aedes (Ochlerotatus) crinifer (Theobald) ? No

This species is known to occur around Rio and further south, but has not been taken

hereée

 

+ AS. fulvus was found by us in Bomfim but has not been taken in the neighborhood
of the capital.

Rysvveed drew ABN

4) 17 0
' EKS.
FLS 1930.

August lath. JTA wires that Dr. Ferreira Pinto wishes to work with the yf
service beginning September. As FP has been

with the Malaria Service of the Division in the State of Rio for a good many

years, I shall do everything possible to take him on; probably good man to aid

in epidemiological investigations. It was he who assisted me in collecting bloods

from Magé last year.

August 13th. Left Recife at 8:50 AM with ERR in Chevrolet touring car for a
one week tour of the States of Alagoas and Pernambuco with the
following itinerary;
lst day, Cabo, Excada, Frexeiras, Ribeirfo, Gamelleira,
Joaquim Nabuco, Palmares, Ribeiréo.
end day, Gamelleira, Cucai,Barreiros, Sho José, Marogogy,
Pedras, Barra Santo Antonio, Maceid.
3rd day, spent in Mateid.
ay, Séo Miguel, Penedo, S#o Miguel.
ay, Anadia, Tanque Darca, Mar Vermelho, Pindoba, Vigosa.
ay, Quebranpulo, Palmeira dos Indios, Bam Conselho, Garanhuns,
7th day, Sdo Caetano, Caruarfi, Bezerros, Gravat&é, Victoria,
Morenos, Recife.
The speedometer showed a total kilometragem for the trip of 1422; notes were
taken during the trip of distances from one point to the next but ere not included
here as they are of little value in planning time taken; suffice it to say that
each day's trip carried out according to above schedule gave each of us aii the
work Ne wartec for the day drivine only one half the distanceg Drivers were changed
every thirty kilometers during most cf the trip and the roads were such thet sel- }
domedia the man driving forget to look at the speedometer in time to make the shigt. |
However, with the exception of the zone fn the State of Alagoas between Anadia and
Quebrangulo which is really quite a hilly almost mountainous district, the situation
in regard to road improvements can be considered hopeful. Deubtless during the peak \
of the dry season, most of the roads traversed will be in very sood shape. \

 

Palmares service consisting of three guardascand: ene guarda ‘chefe, who also acts
as guarda chefe for the services in S&o Benedicto and Quipap&, was inspected by Dr.
Rickard only minor defects being found. —_——
Ribeirfo. Slept here under mosquito nets; many culex and pléty of stegs about
in spite of part time municipal service.

suest 14th. Met at Bafra Santo Antonio by Dr. Almeida who returned to Maceio with
us. Reports there can be no doubt of the diagno&is of yf in Pindoba,

August 15th. Assumption Day and a full holiday for everybody except the yf service
in Maceid, Announced to Dr. Almeida that from now on he will report

directly to ERR and that gall reports of all kinds are to go to Recife; call on Dr.
Meneschal, director of the State and Fe@eral Health Services here and present ERR
as our sectional director. Discuss possibilities and need for autopsies. ERR goes
over organization and local situation with MA; no changes to be made at present
time. 6 for

Dr. Uchoa wires that Doyle has taken over direation of service Fortaleza, PK

DBW notified price of Chevrolet includes bumpers and shock absorbers.

Authorize Machado to purchase furniture for my office Recife.

PJC requests another car for Par&; Tate of GM authorized to ship from
Recife one 1929 Chevrolet touring car at 4:509$ plus cost of transportation,

PJC wires monkey with blood from Kislanov showed nothing in two weeks,

NCD; Liver Marie Andrade Natal Negative.

Bloods Raymundo Passos, Joaquim Passos, Francisca Passos and Domingos

Andrade of Par& all failed to protect rhesus.

DBW sent copy of yf contract in response to urgent request; should catch
Condor plane tomorrow. I cannot imagine why he needs the contract.

Residence, Edgar Farias, Travessa de Curro 36

Harold Chandler, Trav. Benj. Constant 96 Par.

Ve ewenr*
PLS 1930.

August 16th. DSW returned to Bahia to-day after two days in Aracajh.

ERR MA and I visit service in Penedo, the principal port at the
mouth of the S&o Francisco River. Call on Dr. Jocelyn Fraga, director of the local
health post who has not been too helpful in the past according to MA who believes
that JF feels that he baght to be on the payroll of the yf service. Find very inad-
equate installation for handling fish. Rode through large areas apparently almost
uninhabited today between S&o Miguel and Penedo. Sleep at So Miguel with mosauito
nets; plenty of foci right in the hotel,

August 17th. Sunday. Visit ANADIA again my first visit being on May 19th when I

was here with MA investigating suspect yf; we came to conclusion on
previous visit that the town was free from visible yellow fever and today three
months later were able to learn of no further susp&cious cases. Also visited the
nearby village of Tapera, also under suspicion on our last visit, and learned that
here also nothing further has happened.

Stopped at PINDOBA, 16 kilometers from Vigosa, long enough
to satisfy ourselves that there have been clinical cases of yellow fever here during
the past three months; it is hard to estimate how many cases or even how many deaths
there have been here without making a complete study of the place. From incomplete
information it would appear that some five or six adults at least have died; chtidren
generally dont count in a case of this kind here. Our rapid history taking included
one family where some six persons had been ill with no fatalities. We were also told
that 'many people were sick but few died and that almost all the children were ilif2
Pindéba is a small place with hardly enough work to keep one man busy. Service has
been organized and will be continued until all immediate denger is over and then will
be kept under observation and oceasional inspection.

Spend night at VICOSA; no recent cases of yf have occurred and the
index is now down to three percent. The incomplete studies of MA indicate that there
were approximately one hundred cases in Vicosa from February to June with about
twenty deaths. Ne

 

August 18th. MA returns to Maceié on morning train because of infected leg needing

rest and medical attention. ERR and I drive to Quebrangulo; much more
of a town that we had expected; for all practical purposes the end of the railway
branch and a strategic point. Then to Palmeira dos Indios, the Queen of the Serté&ea
which is also quite a town for an interior point. Control service was mainteined —
here from August lst to December 31 last year because of suspect cases occurring in|
June 1929, On to BOM CONSELHO where we find the guarda working in plain clothes; _j

reports all quiet here. Sleep in Garanhuns.

August 19th. Return Garanhuns Recife visiting S&o Caetano and Hezerros services
enroute. Arrive office 415 PM,
Bifio wires Mage complete with many refusals; wire for him to report
to Recife, leaving sera with Davis in Bahia enpoute.

NCD; MANOBL SANTOS PARA positive. PJC wires MS had leprosy, malaria
and had been dead 24 hours before autopsy and requests reaffirmation of diarnosis
rom - Following wire sent NCD;"Crawford reports Manoel Santos had malaria and
leprosy stoAutopsy performed twenty four hours after death stop Would this inform-

ation alter your diagnosis? Soper."

August 20th, Authorize Rio to continuesending 15 contos per month to Ceara.
Application was made on August 6th for a patent on an "Extractor

de Fragmentos de Visceras de Cadaveres" in the name of Dr. J. Tomaz Alves, pub-

lication occurring in the Diario Official Aggust 8th page 15524, Gide

C yh
Took possession of the new office and went to work. Ws °%
Wired Rio at NOD request that future shipments of monkeys should

come in individual compartments; he reports getting Hinety seven live monkeys out
of one hundred shipped on last shipment. Of course this is the most favorable
season of the year,

Robinson informed that we can order the ten kilos of tryparsamide
he desires for mal de caderas treatments but that shipment will have to be made
to him and duties paid on importation.
FLS 1930,
August 21. My first manipulation of the Extractor of Liver Fragments oggurred

oday at the Santo Ama : on_a cadaver 19 hours after death.
Was quite surprised to find how easily and how quickly satisfactory frasments
can be secured. ,

ollowing estimates submitted to FFR for 1930
Br. Phys. 18 contos 2160.00

 

 

Nursing 20 200.00
Office 50 6000.00
Lab 6 5000.00
YF 2000 300000.00

NCD; Joanna Rodrisues, Par4, negative.
NCD copy of letter to PJC asking for collection of blood specimens from Part
for filiariasis studies of duly 28th reecived; I believe such matters should be
approved and arranged by me rather than handled directly between the laboratory
and the field units. Shall discuss the matter with Bavis when next in Bahia.
NCD letter July 26th," Upon my return from Par& I allowed myself to be per-
suaded that the Santos case had malaria only. My present opinion is that yellow
fever is present. I still believe that malaria takes a part in the picture. However,
probably most of the pigment is the result of formakifmfixation." This refers to

the Maria LEONORA SANTOS case, BELEM PARA March 19th 1930,
CFragas letter of Ausust 13th translated and forwarded with CF letter to MEC;

MEC apparently gave CF to understand that he did not expect to return to Brazil.

August 22, Advise Rio and DBW and PJC that I shall arrive in Bahia August 28,
Bl&o sailed from Rio August 21; should arrive Recife August 27th.
Biao will spend a couple of weeks with ERR in Recife end then will relieve MA
in Alagoas while he comes to Recife for further training in methods. MA has
done very good work in Alagoas considering the amount of assistance he has had
and considering the fact that he is a home tewn boy; better cooperation from
the local authorities can probably be secured with an outsider.
NCD; Carlos José Andrade, Par& protected

Jovenilha Andrade, probably protected.

Walter Gaisle, Ilheos, almost certainly protected.

Manoel Pelletero, Bahia, negative.

Arranged for NCBank here to order payment to Standard Oil in Rio of
218:856$.

Prepared and sent to Rio autopsy note for 0 Saneamento.. \

DBW explains that he wished copy of contract to see if any provisiion
had been made for lawyer's services in the carrying out of intimacées and fines,
(Dr. Carlos Mattos, lawyer for the SSAP in Bahia had tried tocollect for his ser-
vices in connection with collection of fines: ALBB had gone on record however as
opposed to such vayment and inbsEsted that he must continue to do the work as part
of the work of the regula r health service.)

PJC advised that Chevrolet touring car was shipped him this week.

August 25. Left Recife 8 AM for Parahyba with ERR; many military in evidence and

some burned houses seen; many houses still flying black flags of
mourning for the murdered president and some also flying red flag of vengeance!
Reports are that all fighting in the interior has ceased although there may be.
some difficulty next week on the day of the THIRTY DAY MASS.

Met Dr. Rodrigues Perto, who is now in charge in Parahyba; he re-
ports service in good shape in Parahyba but completely disorganized in Cabedello
Present Dr. Rickard to Dr. Alvaro Carwalho, now President of Parahyba, who ex- |
plains that he will do everything vossible to make the yellow fever service suc- |
cessful in his state. Also present Dr. ERR to Dr. Guedes Pereira who promises to |
continue his interest and assistance to the work under ERRS immediate direction, |

GP informed that ERR will return next week for the purpose of going over the

local organization and making certain modifications to conform to procedure at
other points. (Intimetion and fining services not mentioned today although this

is most important change anticipated; atmosphere one of formal presentation of
regrets over loss of President not favorable to definite discussion of details.)
Returned Recife 8 PM feeling day well spent, . .

 

tae es IIA
FLS 1930.

August 24th, Sunday. Day at office. Wired Rio to make arrangements to purchase a
copy of the RIQ YELLOW FEVER FILM.

Aug. 25th. Liver Antonio Joaquim Ferrei 4

POWER OF ATTORNEY made for JTA to receive from treasury 33 contos due DNSP,

Advised Dr. Bailey to sail for Pernambuco rather than Rio;scheduled to arrive
in Recife Oct. 22nd on Almenzora.

FFR advises of suspect yf in SANTIAGO CHILE in May. I consider impossible but
am wiring CF and JBB for details.

Demonstration médel of LIVER PUNCH sent by airmail to FFR.
August 26th, Day at office. notified of intention to leave Rio office without American
in charge; suggest JTA be BONDED to handle all financial affatrs.
NCD Aug.2l:

"In my opinion postmortem changes, malaria or leprosy considered
individually would not account for the lesions in Manoel Santos; whether
or not the combination would do the trick I do not know. Postmortem
changes are rather marked, but there was undoubtedly a pre-existing
injury. There is a little pigment-not mearly so much as in some of the
Natel cases. But there is much fat and Je *trg of the cell columns in
in the midzones { There may not have Doon much actual necrosis; it is”
rather hard to say now on account of postmortem changes. However, there
ere inflated nuclei, fading:nuclei, etc., some of which mpy have been
present ante-mortem. Under the circumstences, and considering pie
changes of undeterminable degree, perhaps I should have said, “Very sug-
gostive of yellow fever." That is still my opinion. We shall be glad
to shor you a slide later."( This refers to case noted this journal 19-8,

. from Belem. _
Bao 2 8 a Tater ren, in Kira Perrrdh= C hrcolemed |
August 27th, Sail Almahzora for Bahia. Dr. and Mrs. Cross, Mr. and Mrs. Goodman, Mr. and
Mrs. Gillette and Mr. Tate on board.
August 28th. Met by Dr, Wilson and get to Pens&o about midnight.
JTA advises SANTIAGO CASE not confirmed,
August 29th. With DBW call on the Minister of Health, ALBB., who is quite friendly at pres-
ent; demonstrate to him the vige . and promise him an instrument for his
service as soon as menufacture begins. insists that ALBB has been giving full cooper-
ation! (Incidentally this full cooperation began aftor CF's trip to the north last year at
which time CF reported to the Governor that ALBB was.not showings the proper spirit; the
Governor at that time promised that no further passive resistance would be encountered here.)
Discuss looal situation with DBW and authorise opening in Ilheos since NCD ,
has reported protection in June case; also in anticipation of extended programme suggest
that surveys be made in following centers which are close to Bahia and would logically be
the first point of attack on extension; Alagoinhas, Cachoeira, Nazareth, Santo Amaro and
Feira de Santa Annna, In connection with Ilheos, Itabuna is to be surveyed and possibly
worked,

      
  

 

  
 

 

 

DBW sugrests that as part of the survey, larval counts be made on 1000 con-

tainers in each point; on consideration we decide to do larval counts in Ilheos only for

the present but to have such counts made weekly thus folbowing the improvement with work
both fram the house index and from the mosquito production points of view.

Rumour has it that the Ministry of Health may change hands with the advent
of the new goverrmment in November; Dr. Afranio Peixoto, at present Federal Deputy from
this state is the most talked of candidate. Fortunately Dr. Peixoto is well known to our
service and is very symathetic to the cause,

Decide on 125000 scale for BAHIA MAP.

August5O0th, Day spent at the Laboratory at Montserrat.

Frobisher's monkey still survives its protection test seven days after inoc-
uletion without sign of fever while the controls and other test animals of the same series
have either died 3r are veyy sick; NCD believes in value of large doses of immune serum

early in the diseawe.
Mage study practically complete; MF would like to secure further bloods if
possible for one year after studies on canplement fixation.
MF has been working on chemistry of fat in monkey liver; Asks if any results
from Wakeman's work are available; desires pure Hexylresorcinol.
NCD reports that MOUSE STRAIN was not lost but that his animals are still.
FLS 1930.

August 30th. continued. dying from mouse typhoid and that the patholagy of the animal
with both mouwe typhoid and yellow fever is not greatly differ-
ent from that of the mouse with typhoid alone! NCD is rather pessimistic regarding the
possibilities of the mouse work although he now has the virus well beyond the 60th trans-
fer in these animals.

NCD and I discuss in detail Shannon's proposed trip to the Amazon Valleyg I
finally approve the trip as proposed on August 7th but with departure from Bahia only after
the preparation for publication of material now on hand; RS estimates that such preparation
should occupy him until the middle of October at least, without taking into consideration
the systematic working up of new species collected. Departure fron Bahia then should be
about the 20th of October.

NCD believes that the entomological work of the yellow fever service can be
more profitably done by-a physician who knows some en cmelogy rather than by an entamologist;
obscure species can always be forwarded to specialists for classification;NCD is not then
requesting the return of Shannon to this field. .

NCD and I have long frank discussion of position of laboratory in regard to
rest of yellow fever service; 1 suggest that we attempt to maintain contact between the
laboratory and the services away from Bahia through me and that the same procedure be used

regarding contact with the New York office. It is true that I shall be travelling a
great deal but with improved airmail service no great delays should occur, especially as
I propose to keep NCD constantly informed by wire of my proposed movements,

NCD insists + oratory is equivped to handle larze amount of work fran

the field and rather challenges the control service to get enoursh autopsies and bloods to
gum up ‘the works; in regard to epidemiolozi udies of immunity distribution, NCD says
the laboratory could Well handle tye Hiivod moe oe Gistribution, NOD says
now received.

NCD has been able to demonstrate variation in ‘extrinsic incubation period!
of the virus in the mosquito with variation in temperature at which mosquitos are kept;
his ability to shorten the incubation period by increswing the temperature may explain the
case reported by Arag&io in which the incubation period was apparently cut down to four

days!

 

 

 

NCD complains that no information is sent out regarding the work being done
in New York and in Lagos and that there is no effective coordination of program by the
three laboratoried as was anticipated last year.

 

August 3lst. Sunday. Dem e with fair results use of Viscerotome on cadaver at the
Asylum to DBW, Cardoso and Magalhaes Neto.

September lst. ANALYSIS OF "SALUS" scrapings by Inst. Os. Cruz. Bahia. No. 268,
Anions: Chloro, sulfurico, phosphorico, silico.
Cations: Sodio, Ammonio, Calcio, Magnesio, Ferro, Aluminio.
Aug. &th Dr. A. Diniz Gongalves,
( And the Propagenda justifies the high cost of these jars because of the silver
used in their manufacturet!!l!t! )
: HOUSE
AM spent with Dr. Gardoso inspeotingagutter gangs. Five gangs of five mn
each are inspected by a guarda chefe. All gutters are naturally ary at the vresent time.
As the work is considered vital however and as the men cannot be easily replaced, the work
is going on as usual but at a somewhat slower rate then previously as each gutter is being
flooded by hand to determine whether it will hold rainweter cr eet. Bross juthers holding
water are punctured with the consent of the parties concerned; where gutters cannot be
punctured legal machinery is set to work to require the necessary corrections. As the local
authorities are giving good support on the enforcement of the law, it would appear that
even during the rainy season it might be well to apply the hand flooding test to all gutters
examined so that a uniform basis of correction might be had.
Of the five gangs visited, three were found to be punching inadequate holes
in the imperfect gutters; EC insists that this is in soite of repeated instructions to make
the punctures as large as the drain phpes. The gutter can-opener invented by one of the
guardas seems to function very well when sharp; I suggest furnishing two to each squad
so that one may always be sharp and in service.