Dr. Fraga.

1. The yellow fever infection has been confirmed in several States and it is

  thought to be present in a not easily recognizable form in many communi-
  ties, and I therefore think it correct to say that an emergency exists,
  and that the entire area of Brazil susceptible to yellow fever infection

  should be regarded as a unit.

2. The reasons for vietcing the present situation with grave concern should be
  freely and frankly stated to the Governors and Presidents of the States

  in the yellow fever area, and their cooperation requested in meeting the

  threatened danger.  The newspapers throughout these States should be

  encouraged to join in the campaign to control the spread of the disease.

3. The infected and infectible area in Brazil is vast, and the present effort

  to control yellow fever is the largest of its kind ever undertaken. This
  fact is mentioned solely to emphasize the colossal problem which confronts
  the Departamento National de Saude Publica and is+he reason for enlist-

ing all agencies in combating the disease.  Hy experience has been that
publicity is the greatest single aid that can be employed to seuure imme-

diate results.

4. The normal flow of commerce may be temporarily2dislocatedr but the confi-
  dence and cooperation of the public will have been secured and this will

  ensure more rapid progress in controlling the disease.


5. The following measures are now practised by the CommissGo Febre Amarella:

a. The elimination of all unnecessary receptacles for
   stowing water.  The families should keep on the
   premises only sufficient water for their daily
    needs0

b.  The use of larvae consuming fish for all containers
   large enough to support fish life.

co The large cities are being encouraged.to install
   modern water supply systems with connections for
   every home, thus elimtiating the necessity for
   stowing water on the premises.
                         (_I

d.  The chefes of the Prophylaxia Rural are requested
   to deny oocupancy of all buildings until all
   receptacles for stowing water have been made
   mosquito-proof.

6. The present intensive control measures should be continued in the capitals

and should be reinforced by the maintenance of one or more guardas (mata-

mosquitoo) in each village (especially sedes dos municipios) of 1,500 or

more inhabitants along the railway and caravan routes.  These latter

should be maintained at the expense of the municipalities, but should

be supervised by the CommissGo Febre Ararella, which will supply a

limited amount of material, such as electric lamps, batteries, etc.

7. As an aid in locating areas in which yellow fever may be present but

clinically unrecognizable, the campaign requires the services oE a
laboratory for diagnostic purposes , which, as the campaign advances,

may extend its program to include research.  The efforts of this special

laboratory can be anticipated by directing that in each locality

autopsies be performed on a large number of cases where death results


-30

from acute illness in from three ,to seven days, and more especially

on cases diagnosed as typho, intericia, dysentery, gastro-enteritis,

pernicious malaria, bilious remittent fever, and fevers of undeter-

mined origin.  From the above cases a liberal section of the liver

should be forwarded to the laboratory for further examination.

8. Yellow fever control measures should be recorded on forms as used by

   the Commissgo Febre Amarella.  Only in this way can uniform records be

  maintained by the different yellow fever services.  The uniformity of

  records will permit of a later analysis, which is not practicable

  when different recording systems are used.

9. The following rules and regulations now effective in S&o Salvador

  have been quite successful in securing active cooperation of the
  public for the advancement of the campaign of the CommissGo de

   Febre Amarella.


-4-

TJma Nota da Saude Publica & Imprensa.

     S. Salvador, 6 - A Secretaria de Saude Publica
forneceu honta a imprensa, a seguinte nota;

    "A Secretaria de Saude e Assistencia Publica, eivamente
empenhada em fazer baixar ao minimo possivel o nosso indice
stegomyco pede a populagao desta Capital, que secunde OS esfor-
90s em tal sentido, da CommissQo Rockefeller, a quem desde Ou-
tubro de 1923Acabe a responsabilidade do oombate referido, cum-
prindo de accord0 corn o art. 550 do Codigo Sanitario do atado,
as determinag2ies seguintes:

    1'1 - SerPo OS moradores responsaveis pela existemcia de
f&os de mosquitos dentro de habita$es, nos terrenos a ellas
pertencentesi

    2: - OS reservatorios abertos devszn ser povoados de pei-
xes larvophagos ou petrol&ados periodicamente;

    3? - OS depositos dagua serao cobertos e cintados corn pa-
pel ou panno gommado;

   4: - OS pequenos depositos dagua para beber, (potes, talhas
etc) que devan ser providos de torneira, serao protegidos de tam-
pas fixas.metallicas, cintadas, de modo a impedir a procriaqao
de mosquitosi

    5: - &3 aguas existentes em jarras para flares, que ago
possam ser providas de protecqao, fixa, ser&i.o systaBticamentg
despejadas todos OS dias , pelos prepostos da reparti#o sani-
taria.

   OS moradores que r&c quizerem se sujeitar d disposiqao
aoima, dever&o conservar enxutos e imborcados OS vases recipien-
tes, por occasifio da visita dos ref'eridos funccionarios;

     69 - Todo o deposit0 dagua, que r&o f& fechado a prova
de mosquitos, antes de receber nova carga, devera ser lavado e
depois de hem limpo deverd ser emborcado at& f'icar enxuto;


-s-

   7: - k b 'g t
               o r1 a oria 8 limpeza de vallas, sargetas,
caixas collectires, telhados e oalhas, afim de evit&r es-
tagna@o das aguas pluviaesb

    8' . - Serao prohibidas cercas de hambus inteiros,
nativos e outras quaesquer plantas que collecionem agua.

    Pelo n&o comprimento desta determinaqires, OS
responsaveis inoorreriib nas multas de 50$000 a 200$x)00. -

         From the above it will be noted that the aim of the

CommissEo de Febre Amarella is to instruct the publio how to apply

anti-mosquito measures in the home, thus placing on the moradores da

case a personal responsibility to prevent mosquito breeding on their

premises.  Under this plan it becomes evident that the guardas must

be speoially trained as eduoators rather than as zmta-mosquitos.

I regard this procedure as holding unlimited promise for permanency

and as economically important.  &ly experienoe indicates that mny

individuals,when they realize how simple and easy is the destruction

of mosquitoes, practice the neoessary measures in their households

without further urging from the health authorities.

10. The Commiss& de Febre Amarella has applied the praotical measures of

  selling at cost such material as torneiras and sealing aaixas da ague

   at actual cost of material used.  These measures aid the publio as

   well as the campaign and permit of economical control measures.

Rio de Janeiro, June 7, 1928.