1.1


1930. Marah 20th.  Arrive Rio 8t30,!PM and am met by Drs. Servulo Lima and
Waldemar de S& An-tunes in additionto Drs. Connor, Tomat Alves: Alfred0 and
Juan.  See Paranhos on the ship. .'
      ci@wakk       t-t/-
laroh 21. Frida;ll. Conference w'th,CF.t'ti$ery optwstic-suggests that survey
be made of the Sao Frsnoisco v
who says that he can relieve
good    $ ley. Suggestion immediately agreed to by MEC
               go from Araoajb for the purpose. C? has had a
   letter from Marehoux twl,ing him how remarkable it is that Rio was oleaned

eliminatihg yellow fever from all Brazil beaause he has the unique opportunity
because the government is aroused on the problenn at the present tim and is  I
ready to back any measures proposed.) With MEC see two suspect convalescent oases
at HSS. One oholangitis-one bronohopneumonia; both ioteris-both have bradycardia;
pneumonia case has pulse of 401

        MEC comes out with direat question as to why of my return to Brazil;
St did you expect to do ooming baok to Brazil now?' My reply in as even v&e
as possible under the oiroumstanoes was that at the time of my arrival in New
York, &@&3's request for six months leave of absenoe beginning in April 1930 was
in FFR's hands; that although FFR and I disoussed the diffioulties of divided
authority in Brazil, there seemed to be no urgenoy regarding the situation since
I would return to Brazil in any ease only shortly before the first of April t
that the news of MEC*s withdrawal of his request for leave had reached me only
on the eve of my departure from WY for Rio sud during the absence of FFR in
Europe. I therefore returned to Brazil to reassume the position vacated iwNov.
l&EC then explained that the RF had granted his request but had informed him that
he hadoverstayed his leave  and actually owed the Foundation time; this time
will be repaid by sometime in June of this yearr MEC thereeore suggests that I
go North as soqn as possible and return to Rio after a scsnewhat rapid inspeotion
of the yellow fever service so that he will be able to get away for EY before
everyone goes on summer vaoation from the New York offioe. MEC.sain reiterates
that he found control of his service difficult because of d%l~ authority vested
i=C and-d.

-MEC says that EP closed out diet kitchen at Arthur Bernardes Hosp.
as a way out of her offer to put in sir extraotors at her own expense whioh offer
had been acctepted by Dr. E. Mattos. l&EC believes that usefulness of EP in Brazil
is past but that RF should not think of withdrawing fram n-x-sing service/ Instead
should carefully select successor to EP.

Maroh 22. MEC offers ARAGXO 12 monkeys for further work at OCI/ It seems that
gave rnment money for the purchaw of monkeys has run out.  (~C'S readiness to
aooede to
Fra&isoo this suggestion as well as to CF's suggestion regarding the &o
     ma#e me stop and reflectt)

Harch 24.
BIaroh.

Drive with Dawsons and Einmonts to Tijuca. Dinner <z MEC at Internation-

I.  Call on Fialho, Plaoido Barbosa, Lessa, Range1 and Magalhzes.
Sail on Itsna& for Par!. (PEG's  d eaision that I should leaveimmed-:
_ -

iately robbed me of the pleasure of showing something of leprosy in Brazil to
one &f the granddaughters of Queen Victoria. However, I turned-the task oPer to
Dr. Arminio Frgga who tells me that that lady is somewhat elderly and nott too
attractive.  HOMitchell and family on Itanag& also Mr. Wilcox If EBend S Co.
larch 26. At sea.


                     53.  7 ;*,;p;
March 28. Wilson, Davis, Frobisher, Cardoso, Cunningham on docks. Spend A$! at
office; write FFR as follows:

Bahia Brazil
March 27th 1930.

Dear Dr. Russell:

          I arrived in Rio on Maroh 20th end to&k the first boat for
the North arriving here this morning. One of the first questions asked by Dr.
Connor after my arrival in Rio was whether eny change had been made in the
division of authority in this field to which I replied that the matter had
been discussed between us in December but that as fan as I knew no change had
been made. Dr. Connor then asked what I expected to do in Brazil at this tirr:e;
I replied that.&% the present time the Foundation's programme in Brazil is
largely &imited to yellow fever control work and that at the time the question
was disoussed in New York, Dr. Connor's request for six month's leave of
absence to begin in April was in your hands; his later withdrawal of this
request cane to my knowledge only on the eve of my departure from New York for
Rio and at a time when you were in Europe; therefore, I assume that I had come
back to Brazil to make myself as useful as.possible in the yellow fever osmpaign.
After due consideration of the situation, Dr. Connor reoommended that I come
north on the first boat and visit all the stations during the next two months,
enabling him to leave for New York in June. I accepted this recommendation and
am making this tour of inspection, leaving the direction of the work entirely
in Dr. Connor's hands until my return to Rio about June 1st.

Very Sincerely Yours,    Fred L. Soper.

  Fix up letter to New York regarding depreciation of Pontiac oar; ie of
Packard car on the basis if Pontiao sedan. Call at both Davis and Wilson homes
and dine withwilsong whe      1s to leave at fiw m aa scheduled.
   See Dr. Magalhaes N     g-G
late May or early Ju ne.           our samng to Rio ooinaide in
  Dr. Barros Barrett0 sends up word that he will reoeiw me at 2:3C) P.M,/

Wilson Davis Cardoso and I present ourselves at the apgoin'i;ed hcur. BB pretends
to be deeply absorbed in offical papers and routine and ourtly nods US to seats
as we enter. After scme delay he domes to oonwrse with us and after a wry
chilly hand shake, 'De que  se- trata?" I contain myself as well as possible and
explain that I have just arrived in Brazil after an absence of some months in
the United States during which time I was entirely out- of touch with the work
in Brazil; that my present trip to north Brazil is being made to again femil-
iarize myself with the situation, etc. eta.  BB finally comes clean and says
that he has been so nasty to me personably beoaase I refused to import scales
duty free for his servioe last year; that he is sure that no one has given better
oooperation to the yellow fever service than has recently been had from his
service in the state of Bahia 'with no profit to him' but that he is not sure
that others have been furinshing help disinterestedly1 Fran this the discussion
is turned by BB to his losses on the importation of monkeys; I assure him that
the RF is anxious that he shall personm%ly sustain no loss through cooperation
with us just as we are anxious that he shall have no profit; In other words
the RF beliews that the oooperation should be a disinterested&one. We part
more or less friends, ie to say at least on speaking terms.

  Wilson seems to feel that inadequate personnel is available for the work
in the vensnt lots end the jungle; I assure him that I have no authority to
change anything at the present time and that all of his troubles should be re-
ferred to ?&SC.  Cunningham is at work on a map of the city; I do not quite
understand this detailing of a physician to a mapping of the
that DBW has not found him                     city but suspect

to the laboratory in the near future.
    DBW says that he does
.plainl$%dioates that he do
trol-(Bahia is a State of Fo

20~000) Suggests he has been a
Barnes was voted increase  of sal


RECIFE/.

March 30.
Bocha come Sunday. Met at dock by Dr. Gouwia and ERR/ Doyle and Waldemar da
     from Parahya and are seen at the office. ERR has a man by the name

of Furtado working wi?,h him who speaks osme English. ERR and family appear quite
happy in RF work at present. Uncle is retiring immediately bpt ERR is giving
this ohanoe the go-by and is oonsidering writing in to FPR withdrawing his
potential resignation at the end of his present period of servioe. ERR in answer
to dire& question from me says that ht suits him personally muoh better to
remain than to return to take up Uncle's praotice at the present time. Com-
plains that MIX forced him to withdrs.w salary increases granted by him in
aocord with authorization given by MEC to DBW and entered in DBW's station journ-
al. Has a good opinion of ~#D~s intelligence and ability but notes abuse of
authority and lack of sociability. MEC requested DBW to recommend#' for the
reguUr staff but this DBW refused to do.

      Suspect oases have been reported from Bonn Conselho and Dr. Amaral
has been sent to investigate them.  From available reports E
will be oroven positive.
          NATAL. -

Maroh 31.Dr. mo Tavarameets the boat and togehter we
s From his reception of us and from his remarks I believe that we
advised him of my arrival in the city. In any case shall do sonon my return from
the Nortd At Dr. Latns%ine's suggestion, NT takes me to see the new Aero Club
where a hangar with two planes for the training of amateurs is found.
deok tennis,                                   Tennis,
      bathing& dancing, billiard and pingpong facilities are also found.
Call on Dr. Christovao Dar&as at the newspaper office; CD leaves tomorrow to
became part end paroel of the Federal House of Representatives on behalf of the
State of Rio Grande do Norte
       FORTALEZAx -  (--J=-y)
    Dr. Samuel Uchoa comes on board and speaks of the need of a oalha gang.
    im that for the present all such questions must be referred to REC.
       sxo LUIZ

    Arrive at midnight; Gchefe comes on board c compliments of Dr. Cassio
        Sail at 7AM.                      Y
April 3.  Deek Golf all day.
        Bel&n Pu-

April 4th. Arrive in Bel&m at noon. Aspect of the river and
since first visit in 1920. Met by Dr. Crawford, Muench and   etownunchanged
           P ilva. (Silva is a young
medico from Rio; claims to be a cousin of CF). Call on Dr. Aben-Athar on the PRuhaQ,
and see the slides of a recent suapeot ease of yf xhich dimn the 19th of Maroh.
These slides look very very suspicionu. Call on Dr. Albino $0
State Sanitary Service and arrange to call on the g         , Dr. hrico Valle neti
Tuesday. Picture of personnel taken at 5PM. Dinner with Euench's and Mrs. Albu-

querque. HM wishes to know about rumour brought by Crawford frcan Bahia that he
                                 .
is to go to Columbia. I t 11 hxn hat
know where the leak of thz inform:tion Iktl   f the situation but that I do not
             occ%zd.

      Call on the Pickerel's with whom we had our first 'breakfast'in
      a little over ten years ago.  Lunch with the Crawford& the children6
names are Elizabeth, James and Porter. Dr. Crawford asks my advice regarding
study leave; I suggest that if he desires study leave a year from now that the
application for it be made now.

  Vis:t drainage gang of our service and find some forty odd men at work. On
Saturdays every available men who is not at other routine work goes on the ditch
but during the week only about fifteen men are available.
  Dinner at the Palacete Muench with the Crawfords. Evening spent in kindly
gossip; Eikum trip up to &X&OS discussed with details of boats, Spaniard and
moonlight. The MS frankly liked Miss Eikum.
   Called today on Mr. Penny the manager of the Bank of London and South
Amerioa and made arrangements for changing the bank account to the names of MEC
FLS and PJC.


                     55.

Sunday. April 6.  BM notes reveal the necessity of keeping Steg data separate
from data on oflzer mosquitoes; either this must be done or the serviae must be
turned into en anti mosquito service and be prepared to handle old cesspools,
swamp breeding end all other problems that may arise. ( Of oourse this in now
the official programme but the men end the organization necessary for such work
have not been @pen.)

    Y reports that oo;>;)er gutters have been incriminated as produoors of
etegs contrary to the laboratory experienoe of Shannon. Also does not find that
Salus clay ie impregnated with silver will prevent the breeding of stegs in
bemmboos used for experimmntal work. BM belarirves that the Bamboo Joint work
has been very useful particularly in showing up the fallacy of the BLOCK INDEX
proposed by MEC. Also pupal cases have been found in dean bamboos on the 7th
day after distribution in the homes.  Steg breeding has been found to occur in
pools of water on the ground under houses where there are brick or cement found-
ations reaohing into the water.
   Lunch end afternoon at the  ZIO with the Crawfords. Cs and MS have dinner
at the hotel.

M.Ap.7.Meet Mr. Reggie Moss and Mr. Freytheim of the local foreign colony. Mr.
Foster Smith of the Tram company is given an opportunity to cooperate and
finally comes across with a promis of two passes for the use of the guarda chefe
and his assistant and also authorizes the purchase of tickets against a monthly
statement. This is not a s muoh as expected but still is samething; the ohange
in the method of purohasing tickets ~3.11 greatly facilitate the keeping of aooounts
in the office.

   With HM visit lowlying district the other side of the railraod traoks where
Dr. Silva was checking the work of the guarda; sanitation may be said bo be non-
existent in this zone; conditions are certaily ideal for the extraneous production
of mosquitoes.

BEL!&. Pop. 120 ooo
     Houses 23 ooo
     Zones 40

   -@CG lOOO#
   GCG A&3400$
   8 GC:  350$
  Chauffeur 250-3

40 zone guardas ;
2 vaoant houses 'i, ,I'-
1 port zone    `G
1 boats ships l@rters canoes
1 oalhas
1 experimental hmnboos
above 230 to 250 mil per month
30 servents working with guardas 12o$     I
6 oilers   180$
12 serv. roof gutters 120$
3 foremen     150%
1 secretary    400$
AssSeo         200
Office Serv.     150
Errand boy      120

HM insists on giving steg index separatev. Says that guardas are capable of
rather aoourate classification and that the to&U index here has no correlation
with the  ste  index. Order for general index only was given by MEC to take effect
Jan. 1,  1930 7 Roof Gutter is now the prinoipal producing focus in the oity;
HM reco$niees that his check index of roughly 12 $ steg does not represent safe
condition; Is unwilling to make estimate on the number of men needed to bring this
check index down.

      Visit Dr. Eurico Valle, the president of the state with Dr. Albino
     Dr. Muench, Dr. Crawford and Dr. Silva and try to explain to him the
basis of*our work. EV states that there are now four health services in the
state when there should be by& o@e; he refers to the PR, the State Hygiene
Service, the Municipal servi.de ' d the Commisslo Rockefeller. (It is plain from
          T
this interview and other hapPen)ngs in Para that the idea has never been put a
CDOSS that the Yellow Fever Ser;vice is now part and parcel of the DNSP/) I


56.

felt afraid to discuss this matter frankly with the President in the presenbe
of Dr. Albino as I could not be sure whether he wished to eliminate Dr. Albino
or Dr. Aben- AthaC.

  Our cortege then visits the prefeito, Dr.      Facil&a, who seems to be
slightly deaf, wears some large diamonds, and promises all sorts of cooperation
to the CF. Here again the idea is that the Rockefeller Foundation is doing the
work here on its own responsibility; the Prefeito himself has refused to give
the service a 1930 offioal license plate for the service car but oomes across
graciously when I show him the need of the official plate. However, I do not
believe that he understands that he is not giving an official plate to a private
organization.

Fsmeus all afternoon lunch at the Muenchs today; Drs. Abetithaf: and Al
                        est of honor end held the field until about

I agree to go tomorrow.

W. Ap.Sth.  Visit governor again and discuss need for autonsies; apnarently pet
need amss all right and the instruotions are given that we should see the
chief of police this afternoon to arrange 'cne details, Dr. Albino and I call
on the chief who oalls in Dr. Oscar Carvalho, chefe do Institute Medico Legaf.
The chief is quite reasonable b;grt OC is frankly opposed at first and insists
that this work and responsibility should belong to the State Health Service;
Dr. Albino objects and apparently convinces OC; arrange for meeting tomorrow
to discuss the practioal details of carrying out these examinations of cadavers.

Dinner with MS at Cs. Bridge!

Th.A.10.  Davis arrives on the,ITaqui&. Crawford and I go with Dr. Vienna to
-water works at Utinga. C takes first ride on *trobleyl Water works lacks
filters, laoks ohemical treatment; fortunately the watershed is almost without
inhabitants. ( Eisler reports that tis study showed need of ten thousand cantos
to give adequate water supply to Belem. Pipes for sewerage service have been
mostly laid but there is no service.) Water service is without meters and most
houses in the city pay the min&mum rate of 5$ or 6$ per month.
    Davis gives case of March 19th as provisionally positive after examination

        Met in S&o Luis by Dr.
morning         &sio#Miranda and Jo& Gonzalez  GC. Spend
  gitting a general idea of the city and visiting the drainag: work being
done by the yellow fever service; Visit five buildings in the business district
with the GC finding one focus in a tina in a bathroom of a tailor dhop. CM
takes mato oall on the president of the state,Ds. Sexto Pirese we discuss yf
situation suite frankly with him and also bring up the question of autons' s; CM
immediatels feels that he is on the oemve e,na assures  tn e
hopes to 8e                 president tilt he
     t a series of autopsies to prove whether yf is present or not. I

assure the presidente that the shortness of my stay in SLo Luiz is due to two
facts; the direction of our sereoe is in the hands of Dr. Cassio Miranda and
the city of SLo Luiz has one of the best water plants and water services in
all Brazil.


57.

Ap.12.Cont.
         Personnel- GCG    725     Houses 8500
                3GC     350           4600 with water
                 17G     250          3200 with sewerage
                  2Bcntb   180
                 6Serv   180    All zones close on Friday and Saturday
                 1Sec    100     is devoted to casas fechadas.

About ninety percent of fooi in S.Luis are steg.
Dr. Miranda requests kodak for the service.

Visit statue or rather marker on spot where, 'Aqui foi enforcado o BequMXo
a 2 de Novembro de 1685.*  BequMXo is today condidered one 8f the forerun-
ners of Brazilian independence.

Ap.13.S~. Dead day on the Itaquici.

Ap. 14. Arrive Fortalesa earl and am met by Dr. S.Uch$a. Ficlaalize in PIV; with
GCG Telles. Z14B1.127    1 13 P
         Z15B1.135   2/13
    With Dr. Uch^oa visit his new children% hospital, called"Hosp&tal, Dr.
Demosthenes Carwalno."  Visit the IR-~~o wxTcm machine shops installed by the
federal government to do repair  work on engines end cars of the railroads here
in the north as well as make available for local industries a type of service
on large machine rftpair jobs not previously available in this section.
      Dr. Uchoa gives me many details of changes that have been made in
the service of the PR since his arrival. Hepromises to give me later printed
reports presenting in detail the changes discussed.
      I discuss with SU my recent relationship with ALBB since he was in
the office in Rio last year when BB and I had one of our warmest arguments.
      Service here uses a printed label giving date of visit end address
at which key may be found to be pasted by person making visit on each casa
feohada.

Tu. Ap.15.  223 l/12        224  l/17       234  3/13
     Also found one foous of anophelines in jarra, larvae undoubtedly

having bJ?en brought to the house with the water.

     Visit VD dispensary where from fifty to ei$hty new cases are regis-
tered per day. Visit general dispensary where the main work is hookworm dis-
ease and-discuss diffioulty of diwosis of yellow fever in children with
Drs. Uchoa and Csmpos, Jr.  The father of Dr. Campos is a federal senator and
so Dr. Campos was rather put out when he was not given the place of director
on the death of Dr. Demosthenes.

Break two cement tanques and one cement ant ring about tree.
Dr.SU convinced that the only remedy of value in the treatment of

cases of intoxication with oil of chenopodiu&is strychninelf 111

    Dr.SU asks me to forget for a few minutes that I em the director of
the RF in Brazil and listen to his remarks on the telegram from Dr. MEC
asking for information regarding the ease, of gasoline purchased from the
SOB. SU says that this matter could have been handled much better through
a polite letter than through a telegremm with no politeness in it which
must go into our files and plaoes him in an undignified pos%tion in the
eyes of our office staff both here and in Rio. Of course I make what excuses
and explanations I can; among others suggest that MEC was not born in
BraGil  "as I wasn/.  SU says that he has worked with Americans in RF end
that he is willing to overlook the telegrem but that MEC oannot expect for
cooperation from the directors of the PR with this kind of treatment.

AP.16. Ash Wednesday,
236 1/21,lp.   244

das Cinzaw.  235  3/19,lp.
4/2O,lp.


Total Fiscalizations to date in Fortaleza with Guarda  'ti
                       91148 7  12.8$

Ap.17. Quinta Feira do PaixEo. Checking behind guardar Zll
pupa in deposi;ts left by guarda. Others in cocos.)      4/20 (2 with
                                          221  l/20
    Visit the eone of the matadouro with SU: he suggests that the service
be extended to include this rapidly growing zone where some three hundred
houses exist.

Ap. 18. Sexta Feira Santa. SU spends the morning at the hotel discussing the
situation in Cear&..Insists that our personnel works much harder than does his,
does not observe the semana inglesa, and has more work to do during the rainy
season than can be comfortably done. Suggests that he be authorized to hire
four more guardas for the service. I romisg to write MEC by airmail tomorrow
regarding his suggestions. ik&AbJ $
   Political Situation. Dr. Jo& Mat cG,dy#rg~~ 3u#.*.
                       OS Peixoto the present governor of the

state was previously diputado federal and leader of the bancada;was one of the
first to support the candidacy of Julio Prestes and gave for him more votes in
the last election than some of the states with a much lar k er populatione is
believed to be in line for the Ministry of the Interior  under whioh comes
the National Department of Health) in the new government lineup0 if he does
not go to Rio as Minister he will remain two years more 6s president of this
state. There is also some talk that the political debts of the new adminis-
tration to the state machine will be paid by the momination of Dr. Tome&w
senator, as Minister of Viaggo; this SU considers less likely than that Tom6
will become governor of the state when Peixoto goes to the Ministry of the
Interior.
   Prophylaxia Rural. Budget has been recently increased from 400 to 500
oontos ; Lepra and VD now gets 35 cantos from Fed. Treasury but as state-in
spending 102 oontos on this service, the state hopes to get an increase fro@!
the federal government to this amount.

     Population of the state is roughly estimated at 15OOOOC in some 74
oounties.County Health Services. SU has brought to Cear& with him the RF idea
of local contributions to local health services. The president of the state has
asked the municipios to help the PR wherever the PR is working; the following
results have already been obtained:

                    The counties of Acarau and Tapiboca are
each furnishing predio and installation, $# the salaries of two employees
hired by the PR and all of the salary of the physician except ZOO#per month
paid by the PR. The GC is in all cases hired and paid by the PR;SU considers
the GC his element of confidence in running health centers in the interior!
                    In Sobral, the county pays house, medico
and two employees as well as an additional special fund of three cantos for
the purchase of quinine as the district is very malarious.
                    In Joazeiro, with 30000 pop., the post
limits its aotivities to trachoma, vermineses and syphilis and is entirely
supported by the PR; however, SU is getting Padre Cicero to install a 30
bed hospital, the padre being responsible for house and food for the inmates;
material, medicines and personnel are to be furnished by the PK.
~*...............*............,..................
..*~......*.*....*.*.*.....*....,......~*........ . . . . . . . . . . . . ..*........*...-
                                                     o ? ? ? ? ? ? ? ? ? ? ? ? ??????????????????

The yellow fever service in three states is being
            ctor mro         directed, without add-
                 -Rural. These states are

            and WO-, Actually what5 happening is that we
                     tors of the service but are doing it in such a my
that neither the local director of the PR nor the local medical profession c
can object. ( Of course the directors that are worthwhile in the PR have more
than enough to oocupy their time there and those that are worthless in the PR
are also worthless in the yf service.)


59.

Abpril 19.  Halleluia Saturday.  Behind guarda Z

                                           Discuss once more
the local situation with SU. He insists that our             too hard and
that they are not capable of keeping up the paoe required over a long period
off time-reoommends semana ingles.
        Personnel Fortaleza   24 zone guardas
                    3 other guardas
                    4 guarda chefes
                    1 GC geral
                             serventes
                            oilers
                            chauffeur
                  Total 52

Received following wire, dated April 17th,

Mag6 Stop Connor"      "Two cases yellow fever confirmed during April in
        This is very interesting in the light of last year6 experience
in Magef considering the distribution of suspect oases in Ma@ last year it was
believed that possibly most of the explosive material in Mage had been used up
at that time; the details of these cases should be secured to learn whether they
are local infections or whether they have coQB8 in frgn outside in the meantime;
also whether these oases if resident in Mag6 last year rematLned during the epidem-
io or were among those who fled the soene!          ,*k.-&
A ril 20. Easter Sunday.
Ti!iGT-      Spent the afternoon with Dr. S??!&er taking tea in his
   aughter of SU is now 2 l/2 years old and is namdd Maria Thereza;
SU'S sister for the first time and Mrs. SU again.                   Meet

                                  it6
      Tiradente's day- business houses closed-Ita@& sails at 3PM. Meet
       of the Coateira Cia. in Fortaleza, $$%&J-~+&w-h
A .22. Tuesday.
-b      Ar Eatal 3 PM-met by Dr. Nellio Tavares and CapiMo
m   ary aide to the governor of the state. NT has news of autopsy on suspeot
oase occurring in Mossorb dying on the 17th of Ap. (Francisco Marques) Autopsy
however could be done only after 52 hours.  Liver forwarded to Bahia oare of
purser of Itait&. Call on Presidente Lamartine and disouss yf in Brazil; Par&,
Pernambuco, Ma&, Mossoro'and stress the need for autopsies. JL willing to give
moral snd official support to any programme which may be agreeable to us and to
r* Santiago Varella, the director or' the State Service.

A .23. 22
GE--    3/20 Guarda without notes on houses and containers for which the
assumes responsibility; also has no map of the zone with him; GC without note
boo& Numbering of houses never undertaken by our service here.
     Zl  Z/20 Works muoh better than Zl g has report form well in hand.
   Visit Dr. Santiago Varella and disouss vf and autoosiesj I get an entire-
ly different impression of Dr. Varella on this visit than previously; he is
interested in his work and is apparently trying to carry out the work of the
Health Servioe to the best of his ability; however, he is only a part time
health officer and hence is naturally handicapped. SV assures us that anything
that may be agreed upon by us regarding autopsies will be carried out in the
Capital where he is in charge and where the government is staying by him in
evervthing but that he has serious doubts of the possibility of securing any
routine autopsies In tne interior.


60.

80 $ are isolated.

Ap.24. Thursday.

at 730sm,lunoh As& lpm Mossorb  6pm. Discuss Mossorb case of last week with
attending physician, Dr. . . ..Soares.
     .#                and meet Intendente Vioente Saboya.

h.25. Sadid not ware to report case of yellow fever because of desire to
avoid unnecessaryttrouble to the health department! YF is unimportant in Xoss
orb, S having seen no case during the past fifteen years although he understands
that another case occurred about ton years ago. In spite of the fact that the
case seen by him was undoubtedly yf there were no further oases at the time:
surely there is no reason for spending money and getting excited about a disease
that kills only one or two people every ten or fifteen years in a population of
ten or twelve thousand!  Case last week was reported only because of insistence
of local guarda de hygiene . F&i had severe headache for three days which did not
yield to drugs;came to dispensary of S on third day rather sick but afebrile;
returned home got rapidly worse and died on the eighth day aftereuards. S thinks
FM had been vaguely ill for sometime before the onset of the severe headaches
but has no data; urine showed much albuminuday before death;body markedly ioteric.
S observed left sided ooulrar congestion.

       S takes us to home of Moura: get convalescent blood from following:
  Edmilson Lima Moura 4 years always this house; onset March 17th, sudden onset
                      hout ourse of illness (14 days)
"'~~~~~~~d~%~~~*b~~~~l~e;~4 .d$f$ir EdmiZson and
$ ri davs before FM who lived four doors from here; f:ver
course of illness limited to fourteen or fiftenn days. jxldh&aawn
     lN!rs. Moura supplies the information that a 6 or 8 mo thsold son of
FM died with marked jaundice after seven days illness in February!!?!!!
  Bled also Luzia Amelia 15 years who took sick on Ap. 19th; sick six days
with headache fever a-gastric distress. Lives about two blocks from Priourag,
  water situation of Mossorb is very acute; all rain water is stored for
drinking as local water supplies are not good; stegomyia found in all houses
examined! In dry season drinking water is hauled ten leaRues!

  Conference-with Prefe= `-has been reatly interested in cemetery and has
constructed a new c hapel there wnlcn contains also necroteriol I su~rrest that
5?? e f5FCpurpose and that we desire-to see that    -

purpose carried out. VS says that he is willing to require autopsies in the type
of oases'that we suggest but that it will be necessary to pay someone to perform
                          n; he suggests that a monthly fee

them and suggests that we furnish a physicia

of three or four hundred milreis should be sufficient; believes there will be at

least ten fiUiWQ88 autopsies of the tvpe desired each month; states that the
      -                     ; that M-always has a hip-,h mortality
and that the interior aities many of which receive sup$ies and goods from M
are evers now and then attacked by febres de ma1 caracter; believes that yf is
always present here and that it is from time to time exported to the interior;

M is co-mercial  center for zone extending almost to Joazetfo. I agree to take
up question of autopsies with MIX and advise results later. Local situation
seems verv favorable to undertaking routine autopsies to establish whether M
is endemic center or not!


61.

Sunday Ap. 28.  Lunch at home of Dr. Ignacio; to Aero Club with NT to meet JLyc     L

returning from inauguration of three aviation fields; RG now has 25 landing fields
and 3 under construction out of40 counties.
       Receive wire from MEC dated 24 asking that I hurry to Recife to
confer with EZR about cases in Bcmt Conselho.

These two zones seem to be almost free of

                  *F
April 29. Long day, 520$& $10 pm, on train frcm Natal to Recife.
               s#4l.@abb

Apr. 30. Call on GB,m who is out. Make plans for going to B.Con.
tomorrcm~.       4
Telegrams sent to Rio on April 28th: Rockfound Rio . ..'Am sending three bloods
from suspect sonvalescents of Mossor to Bahia today. Stop. Mossor'o has very
high infant mortality. Stop. Necroterio now under construction at uemeterv.
Stop. Prefeitn 3s anxi ous to have further studies of local situation. Stop.
Is willing to make autopsy obligatory in fever cases of less than ten days
duration. Stop. Are you willing to pay 300'$ monthly gratification to physician
performing autopsies. Stop. Send answer to Kecife. Soper.
                          Rockfound Rio.    Shall arrive Recife twentv-

ninth. Stop. State President and Director Higiene are willing to require autopiies
in fever oases in Natal. Stop. Will yellow fever service pay gratification of
one hundred forty milreis per month to employee doing work. Soper.
-

Answer received dated April 19:

                Ig there is no other 'iyay of securing(autopsy
material am willing to pay physician and employee Stop. Would prefer paying
only employee City paying physician stop Connor.

   From this lx3Et& I inferred that MeC thought that the physician and the
employee were working in the same locality and therefore answered as follows
under date of  April 30. Mossorb is three hundred kilometers from Natal stop
physician to do autopsies Mossorb stop Employee to do autopsies Natal Stop
Send twenty containers for liver fragments to Natal Stop I em advising Tavares
your decision stop Shall go to Bom Conselho tomorrow. Soper.


62.

  1. @and day on train enroute to Gkrenhuns.
&d. To Bonn Cgnselho  1 hr. forty minutes by Ford. Visit Corredor zone of
      city with Dr. iaohado, seeing two mi    pect-oases close to the
bridge, inspecting houses and conversing with oonvalescents
and friends illnesses during the past six weeks. The illness regarding their own
                                                 of   a
caused BllEC to suggest plague was not confined to the Corredor b ,#whioh e
                                          as general
throughout the city whereas the suspect cases of yellow fever occurred only in ,o~qfb
the Corredor beginning at the upper part and gradually working down toward the
bridge whioh separates the Coaredor fren the rest of the city. Suggest to AM
that the distribution of cases and course of the epidemica are sufficiently in-
teresting to justify the making of a detailed map giving location of houses,
and cases as well as other important information. Some culex are still to be
found in the infected zone but as far as could be noted the number of adult
stegomyia is now very low. This is much different from the report of ERR as
to the incidence of stegs just &Lw@e&%ys ago. It would seem that there is a
high mortality in stags and that the number which may be observed in a zone
diminishes very rapidly as soon as the source of supply is cut off. This is
in agreement with the experience of the Nurses School last year where ,the same
rapid diminution was noted when producing foci were destroyed.  I leave Bom
Conselho with Lhe definite impression that the
on the other hand I em surprised that we recei
early as we did if at all taking into consideration the very low mortality in-
       six de_atlh_s iz&sme &zgwusReot cases)/. It should be
       mysician in the place,     -_ _._-_ -_ __
                     and many towns of this size are

without physicians, after causing the looal intendente to notify the eases as
yellow fever, fled to Recife and has not since been available to give inform-
ation regarding the later cases. It is probable that we can still count OS
gettiqg reports of yellow fever in the sertll&o when invasion occurs there but
difficulty will probably be experienced in ,yetting reports from the zone of
the litoral lying between Recife and the sertgo. That is to say, reports may
be expected to come in from the epidemio areas but not from the endemic areas.
Cases will be reported in the cities when the infection exists and comes in
contact with the non-immune foreign population;
border zone between the sertdo          cases will be reported in the
                   and the literal, when the infection comes in

contact with people who have moved in from the sertgo and from the sertgo it-
self in epidemic times.  Reasoning from this, the zone to be attacked is not
the sertbo, but is the immune zone lying along the litoral.

   I left Bom Conselho with the feeling that the situation is well under
oontrol and that there is no danger of an extension of the infection to other
sones of the city.

May 3rd.  SRend day on train returning to Recife. Meet bIr. and Mrs. George
     Taylor and Mr.
Bianchini.       and Mrs. Anderson. Also young agronomist by name of
      Arrive Recife too late for dinner at Lloyds.

May 4th. Drive to Sgo Laureqo XX?! take tea with the Bathams. Meet Mr. and
      Rlrs. Miles also.


63.

May 5th.   Spend day largely at the office in Reoife. Dr. Gouveia de Barros
      called with Dr. Casta Ribeiro, director of Hygiene for Recife, to
return Dr. ERR's and my call of the other day.
      In afternoon visited ditching service with ERTI. Plan adopted is for
serviae to put through the ma$ter ditches needed and torequire the residents of
the zone to fill in ok drain the mud holes in their back yards; this is important
as then more care ~411 be exercised in the duture in the digging of such pits for
getting mud for the construction of mud huts. XSost of land in these sections of
Recife is owned in large tracts and the owners of the tracts are willing to force
residents to comply to avoid getting fines assessed against the property.
      Also visited first day's ?Tlork of i;ang engaged in screenjng vent pipes
of cess pools. Work done ITfith copper screen already roughly formed in the office
appliaation being made with wire and pitch.
      Visit tone of' M,ulsoni production and see pistia gangs at work.

May 6th.   Wire from MEC advises WAS will arrive in Rio May 15th; suggests I re
main Recife until local situation clears.  ERR, AM, and I go to get piece of liver
of aase reported by guarda; case surely not yellow fever.

biay 7th. Class-i.& larvae brought in by the guardas, 67 stegs out of total of 192.
      See P:ge 63 A for details of classification methods.
       Visited Medical School with Dr. Octavia de Freitas.

May 6th.  Muench a&d Davis in Pert. Lunch of medical personnel with Dr. Gouweia de
Barros also aresent.

     Guench rt;ports that he knows nothing of any campaign against the yellow
fever service in Para report d to have been carried out by the Folha do Norte;  says

Crawford has developed three boils  since my visit to the city.
      The Brasil Ndico recently gave notes on a hospital associatinn meeting
in Recife in which the idonisdad of the Rockefeller Laboratory at Bahia was oalled
in question %om elementos" by a Dr. Mariano ti Recife. I called Dr. Gouveia's attent-
ion to this note and he assured me that the men making the charge had no soientific
standing in the c-unity but that nevertheless he would take it upon himself to call
the man to aaaount. '!!his he did and the men has said that it was all a mistake and
has written a letter to that effect and has promised to make due correction at the
next meeting of this association so that correction may be made in tha Brasil Medico.
May 9th. Day mostly at office. Attention called f.o r\rticlo of Sebastiao Barroso in
Brazil Medico of March 29th.                                      s

e -

No-bes on Visit to Medic& School on ILay 7th.

Funds  State annually      50 cantos
     Federal n        100 o
      Students Fees      320 *

Investment in plant      2 075 "
Capital on Hand         1000 n

Students on hand

Medics 297
Dentics 22
Pharmias 3

Professors receive forty milreis per lesson or four hundred :,?ilreis
per month for 9 months in the year.


                       63 .A
Iddyb~;~1930.  Spend morning at the office classifying the mosquitoes brought
    e guacrdas during the weekly collection. Of 192 fooi classified, 67 or
34.9 $ were ppti. Among others found were various kinds of oulex, limatus
and taeniorhynchus .

Notes on classificdtion of local mosquitoes in Recife.

Adults:
    Aedes egypti  lyre on back which may be rubbed off in old specimens
          or sgp~imens hatching in bottles in which case may be
                   en for taeniorhunchus.
      Aedes       taeniorhynchus) looks much like steg but has no lyre
                  ck. Back of thorax is black.
     Mansoni titillans is a black mosquito,rather sluggish in movement and
             easily killed. Found only in zones where pista plant grows.
            Has marked white zone on upper side of proboscis.
     Aedes scapularis  resembles other aedes mentioned above but has large
            white spot on back of thouax.
    Limatus durhami is a very fragile moth like mosquiteo which seldom
              attacks humans. Cannot be mistaken for other conmtonv
                local varieties.
::::::t::; :::::::::::::::::::

Larvae-:
       Aedes

Aedes

egypti-epines on middle and posterior tufts of thorax. One
   row of trident shaped spines on 8th segment. Gills
        long. Photophobic.

    rudimentary spine on posterior thoracic tuft
only. Triangular patch of simple spines ti 8th segment.
very short anal gills.

Mansoni titillans- larvae are to be found attached to the roots of the
        pista a water plant the cells of which contain muoh air
        which enables these larvae to avoid the surface entirely.
bed& scapularis-has rudimentary spine on posterior thoracio tuft
        only. Double row of simple spines on 8th segment. Long
        slender anal gills.
Limatus durhemi- longer and narrower than steg. Brownish yellow. Move-
       ment very sluggish. No spines on throacic tufts. No pecten.
      Very few simple spines on 8th sepent. (Alive is more apt
      to tie mistaken for culex than for egypti.)


64.

May 10. Saturday.  Visits casas fechadas turma with Rickard. Attempt being made
to render unooeupied houses mosquito proof for thir$y days.

Cow pasture pool in the afternoon; dinner party at Rickardls in the evening.
Present Goodmen, Lloyd, Rawson, Hendrickson, Mottram, Tennant, Ingram.
    Callender, Van den Arnd, Italian Consul.

May 11, Sunday.  To Parahyba in sopa- four hour trip as Konsenhor holds up the
trip by ordering jantar at Goysnna.

PARAHYBA. "Iay 12. 214    O-28.   Angld Mexican furnishing oil for Ford. Maritime
visits are listed as house visits. Classification of foci not markc,d on guardas
report, merely verbal report of g to gc each morning at office. WR finds no fault
with 14B but &nits that he had expected to ask permission to print ocher form on
back of FABC in order to get necessary in$ormation for 14B.   Call on Dr. Guedes
Pereira&o is still convinced 3h.S Jacumu cases :xJg yell Oi'i fever and who think
*that yello;j: fever ,wsts in the in&s&rior of his St&e dt~louy,,h ile does not f
know just &ere it is.     'tw- w
May 13th. Visit number of house in'central zone &th mosquito com~&aint;  find
many mosquitoes in several houses but stegs in only one house.It would appear t
that the sudden appearance of mosquitoes in quantity in this zone is due to the
recent rains which either through actual drainage of rain into the  aess pools
or through raising the level of the ground water have so diluted the contents
as to make them suitable breeding places for culex;  stegs found had probably
come from an incompletely sealed abandoned well. Visit vacant lot gangs,and
ditch conservatiom man* Discuss settas and numbering of,houases with WI?.  PM
spent working on reports.  Return visit of Dr. Guedes a$ Hotel. Attend theatlar
with WR and Mr. Vance and see A Mulher do Trem. Taubata Received wire from
ERR

"Davis tires iiver Gaudencio Si'3hra p~>aitive yellow revere. Also had schisto-
somiasis  sto oeveral more cases and 2 deaths Bom Conselho. Stop Rickard."

May 14   ""Sopa " to Recife. Purchase suitcase; call on Ba#ham and on Goodman's;
Agairm go over forms with ERR; receive letters regarding visit of WAS; FFR wishes
&S to visit YF service with MEC; MEC to go on leave June 27th; :SAS to sail for
Europe from Bahia June 24th.'
       , ..; @&ay$.+d>
TZay 1.5.  Telegram to GBYfrom business men of Born Conselho asks for a&d saying
that the fever is spreading and is beginning to kill people and saying that BCE~V-~~-
had epidemic of more than thousand cases + 1919; i;B says this telegrams means
that cases have begm to occur in gente boa and that people from surrounding
towns have learned of the sanitary condition of Born Conselho and are not coming
there to purchase. i tall GB that ?^re think the service in BC is adequate but that
to relieve all doubts on the looal situation Dr. AN is going tomorrow !rith two
more guardas to cheek up on everything4

   ("Rookfound Keoife. Davis renorts tissues Gaudencio da Silva posftive
stop suggest organizing service for all towns on railway syst&m-stop i'hink we
must regard eastern third of state infected stop . . . . . . . . . stop  Connor")&
oh why must we suddenly decide that the entire eastern third of the state is in-
fected? One moment yellow fever does not exist, the only disease present being
plague or psittacosis of cats and the:"next minute the whole third of the state
infected1  We have at the present time no more reason for thi,nking that the
whole third of&the state is infected than we had after Sanharo and Timabauba.
in 28, after Bar Sorte end Pedra in 1929 when cases were also being rgparted
for Aguas Bellas , Correntes end Garanhuns.  Also why should service be opened
in entire eastern third of the state of Pernambuco and nothing done in AlagGas
which is equally if not more exposed to infection from BOM CONSELHO.  An? pro-
gram for the control of yf in the interior of Pernambuco cannot neglect the
neighboring states of Alagoas, Parahyba, Rio Grande dg Norte and probably Cear&w
Forward baggage with Capitan Shulze of the Itanage to Bahia wiring to Dm
to receive same.

Lloyds dine at Rickards.


65.

May 16th. Friday. All day train trip to Macei:. Met by Dr. Jo& de hiendon$a
       de Almeida, ALAGOAS.

May 17th. Go to office to talk over service with MA bv insztions

    of zones. I,IEC last visited service here June 1929. Mendonca discusses the
Leopoldina cases of last year and leaves me with the impression that they yrere
yf in spite of the positive blood for typhoid finally reported for a case from
that plaoe. Tells 188 that suspect cases in Viqosa were re!orted to the Governor 1'1 QYYh
by the prefeito i& letter of about A&l 19th; that he ::rent with another doctor
of the health service to Vipesa on April 21st, seeing more than twenty sick
and taking slides for malaria examinations  all of :?!hich proved to be negative;
bloods for typhoid cultures were all negative.  I suggest that we return to
Vi~osa today as his account of cases seen sounds remakkabl if suspicious of yf.
First call on Dr. L.M. at his dairy, then lunch and leave t 11:20 AM via Ford
arriving at V at 3 PN, @end afternoon seeing sick, convalescents, end getting
histories of fatal cases. I believe there is no doubt that yf has existed in V
since Feb. 17th at least. Two opposite zones of the city seem to have been the
&??h&$&?$-hwpidemic, the center of the tamn showing nothing so far
as is known up to the present. (Steg index taken OR MAs previous visit was '80
per cent for all, zones,incllzding center.) Bloods taken for protection tests.
Arrive in Maceio without jantar at 10 PM.

    "Bight cases febre mau character with black vomit and anuria reported in
Quipapg two deaths stop Brito leaves Saturday to investigate stop Riokard."
-._/,-

May 18th. SU`DAY. Wired MEC,  "Spent Saturday at Viqosa with Dr. Mendonqa stop
No reasonable doubt yellow fever epidemic there stop suggest you authorize ser-
vice Vic;osa and other points stop Blood taken for tests. Soper."

His-tory of some cases of Viposa:

      Jo& Ferreira da Cgsta - 22- always resident in this county. Onset
April 18th; sudden onset headache fever vomiting. Later dcanty dark colored urine.
Noted eyes T!rere yellow in convalescence but thinks they are noipr all right. ( AS
matter of fact eyes are still markedly jaundiced) His sister, I.I:.ria C`andida de
Jesus, 24, took sick in the seme house on April 13th with similar symptoms; on
the third day, 11 began to have bloody and dark colored stools and vomited black
becoming very weak on the succedding days, finally becoming jaundiced snd dying
on April 23rd.

$Plias Leite da Silva. 28.  Onset May 9th with high fever, dhills

headache and body pains. Vomiting reported during-the entire
at first yellow but on fifth day black. Died on May 14th.
       Jose Antonio dos Santos 15 Born in Iiunioipio
Vicosa for one year. Onset April 13th fever, headache, body
day of death had numerous bloody stools. Died ofl April 18th.
          Other histories !ere~ taken by MA which are not

course of the illnss

of Uniao but in
pains,  nausea* On

recorded here.

a MM: wired that Serum fsom Luaia Amelia stop Edinor Lima Moura stop Edmil-
son Lima Moura all of c failed to protect stop."

May 19th.   255  0 steg- 2 culex-lanopheles in 25 houses. Guarda vrorked well.
      Visited the previous palace of the government which has long under
gound gallery which previously lroduced culex in quantity. Bas been been correow
by instellation of syphos at very low cost. Visited places in Jaragua where the
drains are giving clouds of mosquit8es. Oil will not act and neither till the
prefeito.

     Take up question of numbering city with MA; prefeito insists that R
F is wealthy enough to furnish metal plates for houses to be numbered. I advise
MA to go ahead and number the houses according to our system without consulting
prefeito and await results.

     Call on Sampaio the local manager of the SOB.
      Dr. XA has orders to close service in Penedo at end of June.
gest not doing so unless those orders are renewed.
-?--


I'Q~ 19 continued.   Called on Dr. Xeneschal and secured the following informat
ion lYlTFE%ical interest:

           AR)+.PIUCA. Dr. Mgneschal aa:? typical case here in 1929
before our service was reopened in Maceio; notified this case and other suspeets
to MEG who did not investigate the matter further.

vice in Kacei&        LEOPOLDIWA.  Before Zay 1, date of opening of our ser-
         rumors were heard of oases of yf in Leopoldina close to Palmares
p!~ and other doctor 1::ere sent to investigate and saw zore than ten cases lrith
Iever headache body pains snd cnrtain hemorrhagic phenomena. Slides all negative
for malaria. People of Leopbldina insisted that -r:e$le attacked either died in
the first seven days or got well. Deaths in Leopoldina were, Jen 1929 6, Feb 9
Mar 9, Apr 14, May 16 up to 25th of month. Both MA and LM are convinved that
.these cases were yf although a positive blood culture was reported for a case
there occurring toward the end of the epidemic.
               FALMEZRA DOS INDIOS On June 11th 1929 telegram wes re-
ceived stating that Eurydice Martins had todaos symptomas febre smarella corn
grande perda albuminuria. Two local physicians who at first disagreed on diagnosis
decided in favor of yellow fever after watching the course of the illness.
   Euro-dice &.rtins onset suddenly June 4th at 11 AX, fever, headache, back
pains.' Vomiting at first bilious material later (3rd day) black. Black stools;
scanty urine heavy with albumin. Jaundice. Afebrile cm tenth day.
   MA found histories of four or five cases in Palmeira and others outside
which had symptoms of yf with death on third or fourth day.  Ge::t!t r:xtii,e t;r-.. 1' .:
                                                                           ;
in Nay over previous months; Our .s;>rvice or$anizcd. ti 3~:; 1 Fn.5 discontinued Dee.
31.

  Dr. Meneschal also reports that there have been rumors reaohing him of yf
in Anadia, and I suggest to KA that we go there this afternoon although it is
already 2:45 PH.  Finally leave for Anadia via Ford a% 3:30 arrivirg at 6:30 PN
end returning at midnight after seeing cases of fever in Anadia and in Ta?era.
History and distribution of most of cases does not sound like yf; cases seen
did not look like yf.  however , one case in Tapera gave the following history,
    Onset May Filth at $! AM, fever and body pains and headache. On the fourth
day began to vomit, vomit&ng blood tvJice end black once. Stools black. Gn the
fifth day, he appeared to be paraly%ed in the left arm and right leg, dying on
this day.

    One other similar history was reported at an outlying inaccessible point.
   The result of our trip was that we were convinced that most of -the cases
of fever occurring in the neighborhood are not yellow fever although the exist-
ence of the infection of this neigborhood cannot be ruaed out in the light of
the two histories mentioned.

i?Talr 33. ME% wired "Authorize control measures for Viqosa
mai believe necessary.                     and other points you

May 21. Wasted day wait% for plane expected hourly.
   22.  Worked all day,while waiting for plane.
  23. Worked in office all day.

  24th Spent day on Leke in front of Maceio end flew to Bahia ti mti.
    Met at dock by Salver, Cpmor, Wilson, Frobisher, Shannon, Cunningham.
25th MEC end WAS sail for Recife on Araraquara. Wilson, Cunninghem and I
    play hillsiae pingpong by the sea in the afternoon.
  26th Dr. Hagelhaes hreto calls on me at the office and we discuss once more  \
yellow fever; HE gives some interesting information regarding the rate of travel
of the disease in the interior. YF apparently rarely spreads like wildfire but
is a relatively slow moving disease.    Dr. Wilson end I call on Dr. Barros Barreto

and are well received.  Discuss forms with DBY making a few minor cl~enges in head
ings; W would like to have percentage of to-t% foci encoded in eat% type of
deposit but there seems to be no way of getting this information on one sheet of

paper.



-~-"- -

    the poin$xt thet I wish to mpharise rtlti;arding fhis n&ional effort are
-
that
        II. The effort; ww etbnosived ati a remit of the virit of ~nsral

('$Ose;aS and van orgaaitard with the exgeefat%on of elim;inating the disease from the

~ou&sJy throw oontml of the e&pita], oitiee and sucrh atherr plaoes as tight be

rsporfed to herve ths dieems.

      2. This effort, although amply supplied with fVxnde smd men, failed

in rrpite of i*s appewzlt &ueosor kr sl*tfae; the dinaasa fxml the oapital

?????* o

       8. many of the Bratilian worlmrr bm.mm cmwixwed of the futility

of &taanptingtoetadiiorte yllcmfeverfrcmNorth X3raail,throughauontrol

lim%ted to the cmpital o&ties.

       I doubt tithe l.6t0rmmiimmworkern SnBrekeilhwe 0ver qprso

tatad W, ext;Snt and eeriomre of thir Pint attempt to olk&xMw ~13m

fbwrr lhvxea Bwbh lsraailf

   Ilou clre fsx5li.w w%th the outbreasU of l922 md 1923 and the hietory of

the FoMdatioXPr fnte-farol-lrmine; tmwd the sadof the lattmysur, The

flrat Fomdatiien 6-t, if T my eo design8~ the gsriod of Ik', \vhitetr ad

arfnistrat%cm,.grcmUedarrll frcmthB,be~irnine;aabths~wrarbQlibv~dfobe

in eighttien the No Franaisab River and I4mhyba epid&?i~;8 of 1926 spoiled
%hepi&lre~ Thea~epidemio8wmw sttributadtothe raattoringoftha &wwiae

dyingsmbersofthe ~eetionbytIm exospC&malnmmmt of non immune, troops

throughthe intwioroPthammthOcaucr~ inthatyearw The points I wirrhto

4mnphaeire regarding thie first Foundetian attempt are that

      1. The effort ww bckeed on the idma that twntrol of *key oenter8*

of infection muld let the infeCtian burn Itself out in the izrbrier ead would

thue tsutmmtiaellv dicwxmear.


3r FL8toFm my381930

2. This sffort, rlthoU& amply euyplied with fund@ and me+

failed in spite of ite apparent ~UOWLIQ in elbdrat%ng tha disease from the

       3, Oartafn ~rraeilircrm -mrkere beocmu more oaminoed than ever of

the futility of ettesnPt;lngto oontrolyelluwfevw inRorth )~rcuil,through

a ecmtrml of tha dirsur, 1AatSted to the orpital altie..

   The 8moxAd,~tion e*tem& by v&ii&k f refer fa the period fzwn l?ov.

1928 to Maroh 1928, swmred rppau*saf aon%xwl of the rituetion reruUly and fawn

April 1927 %a Marah 2928, o period of &mm xmntIm, no mlpar of ylblluw fever

ware uonfimed in all Bmsil. !f%e happy proapaot of the early elimbmtion of

the diaeam au apailcrd howwer by ant 1803.8bd~oe8e Sn the intsrior of Sergipe

inuwohl928,an ~iaolated~ oam inthe iat;sriorof Fernambuaa ~agrUaAd

       1. The ~iiart~baradopo~idsathatoon~lolC~~osnObrs

of ideatiozl muld btfhs iafe&,~burn%trrslfout inthe initerior nndoathe

urun@bnthatW, pmr5.0~ effwtr hulfailedthrotq$~ ineffioioneyurdia

abflitytama3.ntm~mahkwywnter8 frwaf imfeetiorh

        2. Thlt mooad Formdrtion effort, altlwugh organ&red on a lsrr

uxgennivebtuirthanth~ flrot,wamlin&edinfundr andpr-lonlybyths

$udgitwnt of the direotor tat th8 fsoldt qparently 8uosa8rful in the &tmtpt to

mrintain th8 lmy aenters free of Snfeation, failure '11cu regP8tored in the

largerattaaptk,e1S1&~~ta the d%aaamfmathe aovxxtry~

       8. Cert6in American arorlcercr inoluding mymlf began to Mnr rerioun

doubt8 (~8 Co the fearibility of amakrra%ng yellow fever from Brasi +zhrmgh
aontrblxtmmwcrr liralited to the orpit;rrf oilier and to Char+ interior point8

wherethe dirmw,~tWtirtble.

   That tihlrd Rwmdat~n &AAmpt, by whiah I mfim TV the pried fmm June

l@iM to the prenent, bar beea aharaatsrtied by an inten8ifioatim of control


kmptfrwafvi~ibla &afwt~riaiaa JulylS2Q. (TM8 &atmenti8nuulaignorant
of tha resaXt of exeumfnatioa of livetr of child aubpafed in pardin mreh ISSO,)

      30  The faw worker8 with whaa I ham talked tirioe ths outbreuk in wra
~owelho we allacmvkmodofthe fwtili+yolthe &yoantwprogmama I am
ao2rviamodthatthe dir- 18 oqableofnminta%nAng itself indefinitelyinthe


6    FLS to FFR  my 18 1930

:ttx:x:!t:x:ltttttttt:ttttt$xtttttxtt~tx~xtttttttt:xtttt:r!t::x:txx:tz:::~:JJ:xJ::

   Thed%mwoi0nafthe~~tSanir~ -t by the iuzpwrfbillty of

olaarly de- Ww wwrd  *man infeatible"~ of oourae it meann when applied

to B aityor rrss#mt mahojityor amamyhewe %x&rwIuaed Ma it infeutive

cWUWf3 Of ySllaW fq&= witbiCJU6 th0 prOdUUt%XI Of @tbB blLOd8. It ha8 ?.WUl

longm.moe;nirisd~~e ini'eatibility ofaplvawtd ylhwfemranxld dopad

nwber of ~kne8 OO~til~ OfOO?W8ew&lywith~ diStributiOnoftha,nm


itrmybemorethuna oo~idrmcrethatsgtparently~lete oontmlofth~8e

aapitalr aab cmwmd only in July of 1989 at tit& t&m yellow fever greatly

d4Ballwdinthe fedad cmpitdL'phs Buddepaw of oenem ofyelZuufwer


     slow 2. The Utoral, or relatively name, heavily populated strip,

lwughly parotktiug the aowt ahera oobwiaaal ~isolated' ba80a of ~relluw

zmle 3. 1u*em mm of trtmsitim from litoral to ser-tu&o,

fbumr,
       Boa cowelho 1919
       AgMW B%lltM fsl%I
     $P-+     32928
       BOR r*a%e    1929
        Pedra      l928
       Baucon58lho l9ao

fan, 4. The 8erWa or relmtively arid rparaaly pqmlated somn acmprising

mmwtheleso, h&p to vUuaU.se the problem of aorztral. Qne of the great dif

fioultier in arientine; m.mtr~l oampaigru in Bresail he b&m the hpocsibflity

of knaaring where +fW disease exitsted; the four sonas nusntioned &ova are
believed to preMnt differemt degm& of viribility af yellow fever when the

lnieation e3drC11~ Yellon fever in 8om 1, txmtrary Co t&b opinion held by

ncune, ahotid be resdily vistbles li rather large nmnbsr of foraigax non i~~mtner,

grow%ng up under ocmtml aonditionr are importants faotorr. Yellow fever in


        A~thOPernraabuoo Ah&u reotw I8 but a mall part of the infeot

ible twritory of noti $ruil, an mten8ion of serviom to the intarlor of

there krb r%etaa till ant rerofve tha problem $f rirnih# wnditl,ona obtain

rlamhemm I,bel%meas Wmld reocm8idmChs atire e#tuationandwkeplenr



Originals by airmail and common mail on l~ay 23rd.

w3c
-

Lhceio Alagoas

Dear Dr. Russell:                          Eay 23rd.

         In further reference to the proposed change of program

advocated in my letter of Gd:
would have been recommended 6 18th, I would like to state that this change

fever this year;         me in the absence of confirmed cases of yellow
         in fact, a large part of the letter was drafted in Fortaleza
before such confirmations were made o In addition to the arguments presented
for increasing the scope of our program, there are certain other reasons of
policy which make such a change advisable.

  When Yellow fever was discovered in Rio two years ago, it soon became the
qUestion of Greatest public interest of the moment. There were those who wildly
accused the Foundation of permitting this national disgrace through its failure
to listen t0 Sebastigo Barroso when he lvarned Dr. ?/bite personally and through
the Press that the disease in n&h Brazil could nc3-t be controlled thor 9  a
ContbOf Of the capital cities; Dr. Connor CRITE~ to Rio and talked of t]\e m&l
for a nation wide campaign from the north to the rsouth and from the Atlantic to
the Andes!! to include all the infectible territo:ry of Brazil, Both Dr. Connor
and Dr. Frw amed that there was need for a rcevision of the agreement exLsting
between the government and the Foundation; Dr. Co!nnor*s idea was that the governe
mnt should turn Over the service throughout the (entire country to the Foundation
and PaY fifty nercent of the operating expenses Jihereas Dr. FragaTs idea vfas
that the Foundation program needed his personal s;'uidance and direction. Dr. 'Fraga
made plans as early as .:?ugust 1928 to come north and show the Foundation ho-~ to
do the job and Dr. Connor presented a proposed co.r;trac-? as late as September of
the same year wiich would have taken the entire diaection of the ::ello-rsT revel
services throl?zhout Frazil out of T"ragafs hands.

    strange as it may seem, it was only the s eriousness of the situa-tion in
Rio md the difficulty encountered there in extinguishing the disease, that k@
Dr, Fraga out of the north in 1928 and early in 1929.The greater the dliff'iculty
encountered in Rio and :the longer the infection  was able to maintain itself
there the greater became the prestige Of the Fofxn dation through its ahilbity to
keep the northern capitals ahOSt free of the dis ease during the Rio epidemic.
$0 great wss this prestige at the time the contra ct w-as signed in JangarY of
1929 that Dr. Frage.rs position with the general public and probably with the
government was strengthened, when it became knovra that the Foundation had
sufficient confidence in him to sign a contract cbf' this kind.

  To retu.rn to ancient history; on Xarch 27th 15328, Rocha -Lima gave a
positive diagnosis on the xstsncia case. Fraga 'asked me to insist with Dr.
Connor that steps be taken to prevent the xpread of' the disease. Finally,
Dr. Fraga went SO far as to tell me that Rio de Jan(?iro was without control
of any kind and that he feared what might happen should the disease be intro
duced into the federsl district. ( This was in April;, ata time When yellow
fever undoubtedly existed in the federal district; I have sometimes wondered
*ether Dr, Fraga may not have already heard Of suspeoted cases in the city?)
In any case, at Dr. Fragals requdst I telegraphed Dr. Connor, who came to Rio
insisted that the Estancia case rould not be yellow fe-ver, and that even if it
were yellow fever, there was absolutely no danger of the intreduction of the
disease. Had it not been more or less constantly present in the north during
twenty Years without having been successfully introduced into Rio? Although the
extension of the service as requested &t the time WOUND not have prevented the
infection of Rio de Janeiro, our position was somewhat weaker when the infection
was discovered some six weeks later.

The present contract was signed and approved by the Brazilian authorities
because they felt that the 1928 outbreak had proven once again that yellow fever


could not be controlled by controlling the capital cities alone. (As far as
I know the Drazili.ans never seriously doubted the efficiency of the Foundation
service in those places where work had been carried out. "hen we insisted in
carrying on the owrk on the same  plan as previously adopted, we were frankly
admitting to the world that we dimcredited the results obtained locally by our ser
services from 1923 to 1928. ) The government did not feel that the Foundation WY
could be expected to bear the expense of an interior campaign in addition to
control measures in the capitals) and hence agreed% to pay fifty percent of
the total expenses rather than organize a separate service for the interior. As
evidence of goobfaith and in the expectation of an enlarged program, the
governemtnt opened a credit of leive thourland cantos, six hundred thousand dollars,
to cover their portion of the 1!389 expenses and Dr. Fraga com@ined more than Ed
once during the year thet the mconey was not being spent rapidly enough to
bring the interior under control.

  The present con-k act was signed during Dr. Connork absence from the country;
on his return from Europe in February of last year just a few days before the
contract tras to become operative, Br. Connor and I had a long conference with
Dr. Fraga* p-t this conference, -uuhich I b e 1 ieve occurred on the Z&d, Dr. Fraga
asked for a wide extension of the service to which Dr. Connor agreed, saying that
he would study the situation and present a progranne later. However`, the programme
adopted has been to control the capital cities and points in the interior when
positive &ti&gpeies indicate the presence of yellow fever. This I believe is
a $omew-hat more limited programme than that adopted in the earlier years of the
Foundation service.

l/&en I arrived in Rio from New York in March of this year, no x+w&* of Y,
y&low fever had -been confirmed fo7 the entire country, with he possible
exception of cases in a Minas in the month of Janaury,
ye
?8 r. Dr. Connor and I called on Dr. Fragay who was quit
ituntion in the south but wished to discuss an enlarged programme for the
ITorth. I avoided the issue, saying that I was leaving fn a r"eE days to make a
&JO mont&trip in the north after which I would be better able to discuss
fthe situation tith him/ To take his mind off the north, I told him that I
was quite pleased with the results in the sou'i;h and knowing the way the work
was being carried   on in the federal district since last year that I was not
surprifsed to learn that no further cases had been registered there but that

it was almost miraculous to me that no cases had occurr&d in the St e
Dr. Connor has since -r-ted cases imuth b ui in the meantime we have
                                                         _     Fad

to declare cases in Per&mbuco.

Dr. Fraga considers that his posi_tion is unique; through the recant
epidemic in Rio,, the government recognizes the gravilty of the yellow fever
problem f r
Veither d
Fraga fee b Brazil and is willing to go to any length to sear-e its eradication.
         ds nor authority have bee,n lacking for the service in Rio and
           s that the same is and will be true for tl,e service in the north.
:le feels however that as time goes by without further cttsos in Cc19 so&@, that such
unlimited cooperation of the govern,: ent may not be available and that now is
the approved time for action.

  After all the governement has a fifty percent intcrt?st in the service in th#e
north and a one hundred per cent interest in the service in the south which is
`of course only a complementary service.  I believe we shou7.d face the situation

Fred 1,. Soper.




I ua wring thir firs0 opporhmity to thank

in Rfo de Jmeiro.  I was greatly %nterested in seeing the

rerviw uhiah you oreatsd for the purpose of mappressing

oampletenms of the ergarzitationandthe enthusiasnefthe

de&ore dbeatly in aharga af ths work The fast that no

eaue Or yel&ow fever has been aonfirmed in tha aity of

Rio de Jasmiro r%me lart September is &mug evidmme that

ym afftilr h@va been remrded by tM disappearranrre of the

diwaae jh"clll the ai-&, but I M heartily in agremm&nith ymr

thmght thut the wwk dire&M rgainrt the mosquito rhmld ba

aontinmd tithmtrelaxaticmro thettha aitywlll remeti

Soon I &all be in northern Brasil with Dr. Cannor

8Nl;king inrpeotions of the aontrol xbrk agein& yllar fever in

whioh the Intermtional Emlth Division of the Roakefellar Four&&a


                   2

b&s been p%xticripatiQg+  With regard to this sndamis regibn I m

inaamplsts agreawntwitht~ opinion you exprearaed thatths

~oien;bifiu &udies aa@~any$ng tha aentrolmrk should be
oantitaraaa imd extmded. Withthe developme&of?umr~~   fti-cd.W
it ahmald ba imweasingly parrsibls to dstarmine the prsssnss m .& A4 d&j

           r rrith presision both on the ati s,nd

in the intwiar, und with thfs knuwlsdgo to decider ahers o&al

        to gave mfa gmat pla6lsure to hssr frafl you that
thatgcnrsraaranrti efthe&itedStates of%arUhrrd oos)ptcsd

garp th~u&t that the 0aatr01 of y~ll~nr favor is a natfonal, probleaa.
Xt ia also ntmt enmwagine; to find thut you ace so strongly

infauofth8p- Et&hads of oontral, ozm of ths most   7
Import&f%% ofwhiah istha installstianofmadernandadoquats        '

u&w supplies in all aitsss, sspasially the large mete When

al l&s hsnsas in thasa altiea are acmneated with IUI adaqurte
mpplyamxiUblautrllhours, there willbena~eed far ths

nsmwow lafcpr reaeptemlea whioh nw braed mosquitoes and

Dr. F. p. Rsuasll~ regrettad greatly thut ha Gould not mmm
te Brat11 this yww and aonfer with you.  I sml+ of omme,
m?cempdmtohimregardingmr aonforenaer sn8tha inrpeatiaau

fn the north*

fwmit met again tu thank you for your kin&b888

and rwistanoe during my vfrit,

SinQeraly yours,


                                                              c     _ I --
I!:ay 26   con-binued.                -7
                                                                   :
             Visit laboratory in the afternoon. Find Cabral idle and
others working. With Davis absent he Sam there 3.s very li.ttle for !-:?im to do.
I learn that three autonsies were made h Natal on the 9th. 12th and 14th of
Nay.and the tissxs forwarded to the laboratorv on the 15th. These cases were
without medical attention and were never suspected. of being vellow fever but
came in as part of the program just begun to have routine au-tansies on all
persons dying in Natal with fever of less than ten days duration who had not
been definitely diagnosed soothing else by an aY,ending physician.
        Soverino Santos , 3, dying 9th, reported suspicious by
         Emilia Remos   t 17,
       Jose Felipne Filho a0,  " " 12th, reported positive@
                       14th, reported positive.

' At the time I was-in Natal arranging for these routine autopsies, I had hop%---
of nickinK un somethirx in the course of weeks or months if the infection were
really present but I never had any idea that two &d'.posdib%W three of the first
three autopsies would disclose yellow fever in Natal Ts.,here cases have not been

registered for
1ei;ter of -Iiay l?th. ,

    Telegram received: " Inspeccionei ho&em povoado Anne1 constatando gras-
sar molestia caracter epidemic0 corn dous cases fataes me:: Abril ponto FTistoria
doenca contada mulher Eduardo
Visitei seis d&e        3eror)po morto ierceiro dia suspeitissima PO&&O
                          apoes seguirao Rio ponto Colhi arangue para
provar-proteopao           remetterei primelro NYRBA ponto chemou minha
attenpao grande-          coincidindo apparecimento cases humanos pt
Informa populagao daquella localidade que felinos morrem vomitando em poucoe
dias ponto Consegui fazer autopsia urn: retirando figado gue enviarei nosso lab-
oratorio para esclarecimentos histologicos ponto occasiao em que procurava
colher sangue convaleswentes rua Palhipo visitei doente quint0 dia dexeseis
annos iiade apresentando franca ictericia e intensa albuminuria mesma casa
sua irma morreu oitavo dia vomitando preto e enterorrhagia ponto Extrahi aangue
sua mae Joaquina Maria mais trinta dias data inicio molestia pt

      Telegram sent: Rockfound Blaceio Telegram rega&ing inves !I!@%% Ie-
ceived stop Autopsia gato deve ser muito importante stop Peco mandar tambem
sangue em venulas con e sem citrate para o laboratorio aqui Stop
hope he gets the idea that I want           J&j&.,, ( I
                  Rockfound #@&a 1
                                           8: &-Yd
                                                  e  a reports results of further
investigations in small `towns above Viqosa stop Epidemic with fatal cases
presenting all characteristios of yellow fever associated with epidemic killing
cats stop Cat autopsy material being forwarded to laboratory stop. Am requesting
also cat blood stop Expect to sail for Rio Friday.
                Rockfound Recife: Frobisher reports two of three     b
.livers from Rio Grande do Norte me stop Third considered suspicious stop hz I_
These livers are from persons dying in I__ without medical attention and less
than ten days illness stop Autopsies were performed because of recent agreement  b' '"4c,

for routine autopsies and not because of any suspicion of yellow fever stop
Suggest Drs. Sawyer and Connor visit Natal and request that Dr. Connor                   t
service if necessary. I believeguarda chefe inefficient stop Soper.    1134
                                                                           ik

     The Wilsons and Cunningham to dinner.                                              'k


67.

ldq27th. Bahia.  Learn from Wilson that there wsre suspeot oases of yf in the
     sertao of Pernambuoo last year in the tone beyond Villa B&la. These

oases were never investigated although they were reported to a as suspeots.

       Davis wires that there is a lot of malaria in Natal and that Tavares
does not a to aooept rrobisherts diagnosis of yf'on the routine autopsies
there. This is quite natural. MP replies to me that on8 of the three oases is
absolutely typioal and that another is surely yellow fever; he is willing to
admit,that there may be room for doubt on the third oase but that thinking th
they were all three from the same suspeef epidsmio he made the diagnosis of tha
three on the first two slides.

     visit with UBW tumas de matto, turma de oalhas and turma de latas;
visit ditohing servioe, half abandoned faotory whsre extensive repairs are under
way to fender drains mosquito proof; suggest the use of syphons to avoid part of
the expensive repair of the under floor drains, Visit also the naw unworked zone
along the railroad whioh goes to rlataforma and also make a bird's eye inspeot
ion of Platafonna. Wilson beliews that these ton.88 should be under oontrol as
for all prastioal purposes they are a part of the oity.

May 2Sth. Spent day at the offioe getting up oorrespondsnoe and notes.
     Learn that Burke's Journal is missing and that the large wall map of
yellow fever oases is no longer here. (Given to Beeuwkes by Burke in April 1929)

Spsnd morning at the laboratory; disouss Natal oases with MF and reexamine
May 29th.
       the three slides from there. Personally I beliisve there oan be no do*bt

c+f one of the three oases; on8 of the other two shows muoh pigment and the third aoms*
MY stands by his guns absolutely on one of the three bea yf. I;iok up lunoh with
the rrobishero at the Nova Cintra. Dinner with C at the Mnsgo Edith.

       Mtc' suggests that part of the differenoe in susoeptibility of monkeys
to yellow fever may be due to di&.He has noted that the monkeys in NY whioh had a
more limited diet seemed to show muoh greater susgeptibility to the dissase; I
give him the details of Lsmson~s work with oaloium defioisnoy and susoeptitbility
to intoxioation with CC14. This was unknown to himi we agree that it should be
worth while to starve his monkeys for a few days and them put th&n on a redused
diet to see if any differenoe in resistanoe oan be noted.

Qailing tissue from Edgar kraria wed suspioious yellow fever Dr.
Abenathar. Letter follows. Crawford" &,+c.+~-+-

May 3&h Spend morning visiting garbage dumps with Wilson; also slide down the
olifmind the Bdau sejour to see breeding pools of taeniorhynohus on the water
front. Banboo problem also investigated.

      sail on Gelria for Rio. Conversi with Dr. Estaoio Coimbra and with Mrs.
FW BAmmer whose husband is the organicer of the Kondor smdioate: Mrs. Ranxner
oame over in the Zeppelin last week; oertifioate of orossing the line vsry well
done showing Aeolus playing the uaual role of Neptuae and Neptune somswhat put
out at the lost of prestige.
%i?Pk  Day at sea.
     Sunday. Arrive Rio.  Arrange with Mr. Hammsr of the Condor to give
50 per oent on flights whsn planes are going smpty and ten per sent when passage
would otherwise be lost.

June 2.  Visit Dr. Yraga and talk with Laf'ayette who oonf~       ~@-@lJ
                                                                    ~
$ampos and in munio             notioe of'~oases> e
                  I.# reports interesting sase of an elederly woman
living in isolated         oult a00888 at St. Alei near Mag6; this woman
had been ailing for same weeks, was Ed naixlve born Brazilian and was seen by him
         sioians short1


Coxs on Ellis.

June 5th. Praotioally hireyerreira cia Costa. To be ready for work within aweek.
Thompson Motta oQnes to offioe and assures me that ws will have no diffioulty &r
the ground of the lursets School.

s Dr. Absnathar diagnoses liver Luoimar w as stop Liver from
EdgarrFaria a routine autopsy ease also diagnosed suspioious hsnoe am sanding
liver to Avis Crawford."

MEC to FFR JAB 13.%uenoh reports rumours of an epidsmio on one or two of the
islands in the knason Basin about two days by water travel from iard. Looal
ntrthorities regard the epidsmio ar malaria on the basis of history of these
plaoes in past years. 1 have instruoted Bduenoh to enoourage the looal health
authorities to investigate and failing this we will investigate.*a
But on June1 Wawfordreports that an sngineerreturningfrcsnthe rlha
Mexiana reports a serias of oases there with blask vsmit dying in two to four
days af%er onset. (May 2Sth telegramj

When I ask ror investigation or these oases reoeive the rollswing under date>,
      fY Reported deaths in llha Mexiana were in Plha Caviana stop uootor
$beG?had notioe that oases wers maldia and oonditiopl mush improved stop y'
no boat for fourteen days yet stop two Crauford.&'a
  Jlme 5th Rookfound Par&. " Ilha Caviana should be investigated stop Take
&sry preoaution to proteot yourself against malaria stop should oarry with you
mosquito net and quinine stop oolleot samples for proteotion tests sspeoially
from oonvalesoent ohildren Sopers

# Reoeived following wire from Rooha PARABYBA Tendo UF. Glledes reoebido wnunoia saso
fatal susyeito febre smarella sic&de iilar diets&e aproximadssmsnte trinta kilo
metros oapital averiguei saso naquella looalidade pt uosnte branoa fsminina Hrasileira
dezenove annos   emu vinteaeir faleoeu trinta um oom alguns symptomas geraes
febre amarella';   ndo sido retirado material para exame pt. uoente estevs anterior
msnt ltabayanna ltambe pt todo quarteirgo onde se deu sase foi inspeoionado
havendo doer&e algum . . . . . ..Rooha. ( Sent same.telegram to RooHound Reotie)

INTERESTING EXTRACTS FROM MEG oorrespondenoe.            -J
                                                                           %4+
     l&X to ii%R Apr 13 1930 " You will be interested to lmos that the&y
oalhas (roof: gutters) probism has besn salved in Bshia partly by an &&is&-s& order requi:
requiring proper grades and partly by our punoturing,water holding gutters uhsn the
interested party fails to oomply with requirsmsnts ana partly by offering a prem
ium of $500 per meter to the squad scouring the removal of gutters with the lcnuwleclge
and oonsent of the houseuwner. By means of this iast measure neariy six kilometers
of guttering were rsmoved during two months.L1

        Ml% to PFR Jan 4 1930. G What 1 wish most tu get aoross is the thoi\gnt
that the yellow fever infeotion still appears to me to be not only oontrolable
but eradioable in the wmerioas but to seoure this objeotivs the problem must be 3
attaoked in all plaoes at the ssme time.L-*;R
         MECto'FFR  March 13 1930


69.

June 3 oontinued.

mu tu ~r(a xpril M  in UF. maga is rather inolined to insist
                         regardless of whether
                       laoes. ln prinoiple `>

other than there is money available $#!l:$~~;t~~@ivsr$nay be endemic in groups of
small ooanmunities. 1 think m shall be able -to present some definite data within
a few weeks regarding the yellow fever inf'edtion in the interior of r`ernambuco,
Alagoas and Rio Grande do Morte. ....**-*

       Acknowledged by lrFR as follows "6tating that UT. rraga would like
to have Foundation extend its work to the interior towns but that you see no
reason for a ohange of policy at the present time.-

  round in the files that Ur. Uohoa had reported a suspeot ease of yf from
Narsnguape Ceara in May. Roberto Braquelais arrived from France on April 20
one night in Portaleza then to Maranguape where onset ooourred on April 30.
Case presented typical signs of yf but recovered. Albuminuria of 4.5 per 1.
on 6th day. Teimp baok to normal on 8th day.

* MAY po. t(\m kg- fi=re l-6 FL<
       . . ..The last few days have been extremely interesting.

mae to laok of hotel spaoe uootor tiwyer stayed at the house thus giving me a
good opportunity to get we&l aoquainted. Having received your wire about the
soft pedal I have made no effort to make any speoial sort of a oampaign. There
was no needwh&ever, as ur.              oge;est champion of all your
w He has oompletely g              rysndis expounding on your
endemio and epidemio cone idea; he is also using as his swn many of my phrases
used in that section of my journal to whioh he took such marked exception some
few weeks ago and which oaused him to write me that letter (the one that worried
me.) This morning in 9engthy but interesting conferenoe attended by motors
Mtwyer, Connor, UELvIs and myself the whole situation was gone over. c;onnor seems
to have oontioed uootor mwyer that a greatly &ended program is neoessary
and reoommended that all the states in our sector be supplied with North American
directors, That seemed too expensive and hard to arrange to me; so I put in
a word for Amerioan directors in the more important states as now, full time
Brazilian dootors in the rest and two assists& general inspectors to have
oharge of a northern and sounthern division of our seotor. The job of the
assists& general inspeotors would be to supply the oft repeated fisoalizations
and inspections neoessary for the best functioning of B     personnel. As
yet nothing has been resolved.

    "1 regret greatly that you oannot be here as the disoussions that are
taking plaoe smem to be of greatest importanoe and oertainly the man who is
going to direct the servioe should be in on them. 1 was very happy to hear from
I.&-. sawyer that v &n full-. ~ongratulationsll We shall have
to throw a speoial party to celebrate when you came up again.""


June 6th. Elmcndorf' to HHH May 5th
        ---
         came to .`;ltr-  '~!;';~>7:.fy,i.on of

State of Rio,

However there surely must be a payday coming some time!!  State of Minas information
seems to be entirely lacking in Rio de Janeiro. sinoe January cases close to Dismsntina,
   Interviewed Dr. Guilhemne Ferreira da Costa, reoent graduate who desires to go
to work in the yellow fever service.  Shall look him up and probably hire him for
Pernsmbuco.
         Dine with Ellis family.
June 7th.  Call on Insuranoe company and secure 2546 rebate on fleet insurance of
cars inxorth Brazil. All day at office.

June 8th. Dine with YWCA secretaries  after playing golf in AM with Nave and Ellis.
      Drive to Alto de Boa Vista and over to Paineiras along the new road. All
Rio csn be seen from this road.

,-June 9. Dr. HAragElo calls; has not yet received dozen monkeys promised him by ?&EC
     in Maroh! I s doing nothing on yellow fever at the present time. Arrange

for Texas company to sell us gar#ge service for the two cars now in use.

    Andrade advises that Linte and Beoio desire that my trip to the service in
Niohteroy should be sn official one and that the best hour is two thirty in the PM;
8~s this would mean that I would see nothing of the servioe,'I have refused to go
at this hour but insist on the-original schedule of the seven oclock ferry.

June 10th. Go to Niohteroy accarnranied by Decio and Lintz at 7 AM. They give all
possible details of their service in the least possible time; are quite proud of the
pedioal vigilance service established for the travelling public who must buy tickets
from the Leopoldina railway. I rather throw cold water on their enthusiasm for this
particular form of spending money in yellow fever control and aleo on fumigation;

the method is working like a charm.  Copies of instructions and report form were given
me for future referenoe.

        Visit Andfade's service and find the guardas working in groups which
requires that one man have nothing else to do but indicate to the others which houses
have been worked by the guardas which are ahead of themi this service de arrastero
does not seem practical to me as there is a great deal of wasted time. It does have
the advantage however of having the entire personnel always under the eye of the
guarda chefe. I believe the requirement however that the guarda chefe should gc! into
each and every house examined by the guardas is not practical as he would need as
much time as the guarda to check accurately the work of the guarda.
guarda chefe with a lantern and it an old type non-focussing one.
    Davis wires th,a-t Natal cases are probably all malaria. ',
                       positive.!!ltt!ttt Wire C
%pmgr Pz: ~~v?~~ending him Dr. Ferreira Costa.


71.

June 50th. continued.  Lucimar Passos was discovered by P JC accidentally while out
    fidcalizing in the Val de Caes zone. Learning that a child had died after sev en
days illness he was finallyable to convince the parents that an autopsy should be done
         t that the only indications were that the cFiild had died after
          although known to have malaria, and that th body was slightly
      then can well be considered as a routine aztoosy fram the stand-
point  of the epidemiology of yellow fever in Par& The other caseithat of Edgar Faria
is one of the routine autops$es beigg done under the autopsies of the police depart-
ment.

June 11th. Sail on Northern Prince  for Bahia. Cabin mate by name of Warnau, French,
    temporarily to direct the Bahia Docas company.

June 12. on Board with Dr. Torres and family.

June 13th. Arrive' Bahia. Cunningham meets 11pa. and together we go to the Flandria where
      we find Drs. Sawyer, Connor, Wilson, Frobisher, Davis. MEC sails for Rio.
      Long discussion with WAS.
June 14th.  AM calling on BB and Araujo both of whom are absent; purchase passage for
      WAS, change money and aake arrangements for flying trip to Aragaju.
       Visit Dr. Ferreira Costa on board Santarem and give him letter to Dr.
Crawford.

WNDAY June 15th. Meet Briggs, American Consul in Bahia. Spend &+discussing various
         problems with WAS@ visit British cemetery. Golf in PM; dinner at

Datis home with Rockefeller family all !!resent.

June 16th  To lab in ANI and for lunch; learn that 100 monkeys are to be used in the
      Mag$ tests.  Frobisher administers 1st shot of OCI typhoid vaccine to me.
Davis wishes to continue shipments of loo monkeys per month and will ship Arag&o
the 12 monkeys promised by MEC in March. Davis presents proposal for leave March
1st 1931 but states that from now till then he expects to be almost continuoul&y in
Bahia.  Requests loo bloods fram south Brazil from uninfected zone for control
work. Davis requests commercial carbon tetrachloride in place of c.p. -..uses for
killing mosquitoes.

      Conference with WAS: outline my immediate plan of operations which is to
e&end control measures to the interior of Alagoas, Pernambuco, Parahyba, Rio Grande
and Cearb.  Bahia will be developed only after this central triangle or quadrangle
is organieed unless epidemio oonditions foroe our hand earlier. The Amazon region
is probably to be considered a separate field for investigation rather than immed
iats control. Conourrently with the developwnt of interior stations field and lab
oratory studies are to be carried  on ; suoh studies should show wher 6 our programme
has gone too far and where it has not gone far enough. W.S spontaneously suggested
that Alagoas and Parahyba should be under the same direction as Pernaribuoo; I
agreed saying that I had already considered suah a grouping which would probably
also include Rio Grande do Norte because of railroad and auto road communications
w%th Reoife; also that I expeoted to place Sergipe under direction of the Amerioan
dtiector in Bahia and probably Maranhgo and Piauhy under the director of Ceard
when that service is organized. WAS said that he                            1 '
ing of these thre 8
    C ERR bothof *had opposed it on the
               ssed the group /'I
                                                                e;

-grounds that it was not well to have servloes over *ping statanes.
    7~' tells 'WLS that oalhas are a big problem still in Bahia and that
only last'week IXEC authorized three more turmas for that work; ?lrAS non-cotital
on letter of MEG stating that oalhas problem in Bahia had been solved.
       I discuss with DBllj some of the plans for organiztion in the future
and suggest to him that he get the looal situation in hand as well as possible so
that it may be a event-&-b di_reotor (Brasiliann thus making him
free to superintend the work in the interior when extensions occur.


72,

June 16th aontinued.  Tell DBW that I expeot to replace DoHe with Cunningham in
    Sergipe, placing Sergipe immediately under DEWS supervision.
    NCD brings up again the question of reimburseing ALBB for monkey ex
penses; I have already approved such payment in case proper receipts were present
ed.    RBraquelais Maranguape Ceara protects.
     Four Pbloods VICOSA ALAGUS protect. 4
    DBW and I visit Magalhaes and Cia and settle for oalhas illegally re
moved by our galha gmg. Original bill for 900$, cost proved to be SOO$, SF to
pt~y 300$ whioh will be eventually deducted in monthly installments from the sal
ariss of the men doing the worin.

Acoompany WAS on visit to In&it&o OC and Dr. Araujo.
Ask DBW and Magalhaes Neto for population statistics of interior Bahia.
WAS and I agree that Shannon is to be under NCD for field work from now

on,

   lK$S believes that I should keep a station journal from now on submitting7
same to New York.          +TL./J&~ J
J-e 17th. Dinner at Frobishers apartment.

June 18th.  visit new water works construction with ALBB; project looks very in
adequate as the amount of weter now running through the dam is very small. Future
progrm covering a period of five years is supposed to give available water for
double the present population of the city.
      Show'GAS change of contract and motion pioture statement in YF' annual
report for last year.

      Advise Cunningham that he is to go to Aracaj6 as soon as the map is
finished8 he asks WAS for laboratory or epidemiologioal assignment.
      NCD says RCS will go to Mao&o June 22.
June 19.  DBW takes WAS and Fs to get the Condor plane leaving at 6
    AM. ( Fare after SO$ reduction 210$.) Arrive Araeajlx 8:15. Met by Dr.
    Doyle and Dr. Tourinho of the State Realth Department. Spend the morning
    with Doyle seeing some of the diffiaulties of the local flooded situatinn.
     ARACAJb. 40 OOO-flat and surrounded by water; ground level (water) high
    right now being about ten inches in most parts of the cit;r. Streets are
.very regularly laid out at right angles but wrfortunately for the present cempaip
are at a higher level than are the surrounding lots so that tin water cannot dra5n
away. Backyards and unpaved streets with pools are now breeding sore culel?: end
enormous quantities of taeniorhynohus. Fven relatively dirty pools in the streeBs
are found breeding. ibr(JDasks for more nien for the local service at least during the
rainy season; all of the local people insist that the present ra%ny seaeon has d en
the heaviest noted over a lsrge nU.rther of years,
                        Personnel
       Present                         Desired

11 zone guardas
  2 revision *
   1 oasas fechadas
,-i13 servants
/ r4 fishermen
[  4 roof gutters
',-.,+< 1 Caixas d'agua
; 1 office
I 2 ditches end lots
'l. 1 oiler
`3 secretary
   1 chauffeur
   1 fish distributor
  2 guardas chefes

13 zone guardas
2 mother foci
1 casas fechadas
,,15 servants
/'4 fishermen
\ 2 roof gutters
\l aaixas dtagua
"Tl office
5 ditches and lots
>i? oilers
1 secretary
1 chauffeur
1 fish distributor
3 guardas chefes


73.

June 19th. continued. x~D.4 request for increased personnel really 11jean8 and in
     oreased expense of 9608 per month3  2 guardas 420$, 1 guarda ohefe
3OG$, two servants 24(%/o  (on June 20th after beooming more familiar with the
loo&l situation ad. discussing with KAS the relationship of our serviCe to genera 1
mosquito control, the following was authorized, inorease service by two guardas
and one guarda ohefe and one praOticante* Seeing large number of dead fish in
oontainer, de&h mdoubt&.ly be5ng due to negleot, I SUgf$eSt t0 l?!iJD that he PW
&aee fish by the thousand alive twenty four hours a-fter delivery; raising the
price per thousand to get fishers to work rather than putting them on the monthly
payroll.

     Authorize Doyle to use petty cash funds for PerSOnal eqjenses if neo
essnry as it has been impossible for him to secure money on his letter of oredit
here; however, expeot to have Cundr&mm advance him money to be returned through
the Bank of &az3,1. ~~180 request Boy141 to show on Form 24 Dis+;ribu%ion of Advance
     mc tires cmirxj&-in June in Itaooara, E. do Rio.
   WJD ~tt~f~s '&at the local water sup;,ly is far fro17 suf.i'icient wi-th ~7ressure
only between the hours of Cam and 4: 30 pm; approxi7:etely one tilird of the house::
:; -Q ronizcctod-
   ., I       Aracaju has a. very good seTrage disposal plant whicil :;erv-es only a
very ~~3.1 1. ;&-L  o:I.' fllc? city,
    Ius  WJD and I s?~cnd t-he qf-terrmnn seein',' tulle
                             , c
city is 10~: and flatLGith iilany of             L    ~~oilnd breeding pro~blehl; the
                            the stree-ts hiLh:E ti-r:m tlte lots; this years
flood coniitions have caused. many hous"z to melt aJvay from below and otllers have
been flo,:ded from stem to stern. Taeniorhynchus breeding has been and is a
tremendous problem; culex breeding comes second just now. Tifisi+;&i nine houses
f i.nding two oh; foci, one in a flower pot 2nd one in a ba-rrel. Dac]FJTJc?rds s;sl.t-e
large colonial clustered foci of T.  D has atiiem~tod control by fish, by oiz
and by drainqe. Fish ?t?r~v ;;ivnn re~~s.rkt?'ble reslilts j.vl cer-&in ;ras :;?I r)ools :i&ich
8.32 first Llanee would appear to faVor the l.zrvae; SilltLll adjacent >c~ols 3ithou-t
fish were found breeding in one 'rtoille where the r:ore fevorab2.e r"oci yroro Yis'heC, und
clean of larvae.  Visit zone being drained 'by our service; there c:an be no doubt
that the zone needs draining as the flooded conjitions render even regu1s.r Ilouse visits
difficult; WAS and I discuss drainage in relation to our progrmme and deci.de that
it should be limited as much as possible,  ~lthou$ Da?/-j s secured trcinsyli:;Ffon with
the emulsion of' infected T. he was never able to secure infe,ctio;l -I;ilrol,>& -t;)le bite.
Problem of local drainage should be one -to be settled by local authorities with
local bud&!;s.

June 20.   FLS   28 lstel;, several T. zncj. ciilex in lands and ;~ools,
        WAS   48 Osteg

      Call on Dr. Tourinho at Health Deuartrl!en-t *snd I-lake arrnn;e!lent to visit
governor with whom we disnu:s drainage and(auto:,sies  Al.1 sup-3or-t on both ;3rogrmls
prorlisod. Call on 'I'heopbilo Da.ntns, - lntendente OJ? Aragaju and brother of h.nO&.
Da&as the Governor, TD promises to let Doyle know tolmorrow T&& can be done &out
supplying add ri-lkionai ji?en to ~oork under Doyle 1s sirection on omer~ency drainage.
I do not somehow expect vzry rr??ch.  \ isit Insti-i;ll i;o Ar-(;lLi~r Uernar~i.es 2nd. meet .the
chemist, Dr. l;lraganca, who wishes to know 3I~cn he can 1133e -the icll01~sX.p so freely
pro;;iised him by Dr. Connor.  /&S,WJD, FLS, Tourinho anti UraGanca go to Cabrito to
SCC? -the waterworks.  Instal 7 ation is very modern with rapid sand filters, lacking
only cmorination to give entirely satisfactory supply. 13. insists that $enty of
mxter is av&lablc for twentyfour hour supply but th3 t the com,any is forced to
cut off the su;?~ly at ni.ght because of the absence of water meters; faucets and
hydrants are neglected and water runs in many homes throughout the full period ol
pressure, 3. insists -that collit~p0ny woulti be glad to maintain twent;follr pressure if
hy~irometers were installed. Get stucla several times on .the return trip of 18 by.
but are finally resclxed b y a band of assassins :'rom the penitentiary where we take
coffee before driving on in-to the city.

                                    (?tmd!Yd
               dAs?-_
June 21. WAS and I arrive in Lnceiorfrom Arncaju by the Porto   esre  in about two
     hours time at cost of 135$ per capita. Ke-t by Dr. Aimeicia;  -talk with Dr.
Lieneschal and notify of confirmation of Vicosa cases by protection tests. IYAS
agrees with vte that we should not  be responsible for conservation of draj.nage
and Dr. Pdeneschal also agrees that the respobsibility should be his but states


74.

June 21. continued.  that during the -?rssent year there are no funds available
       for this service. I then agree that we ~611 maintain twenty lncn for this
service as at present until the end of the current year but thut after the first
of J3nuary that these :.len will be taken off. Xeneschal agrees to have funds for
this service next year but S;~YS he l*:ould like to have our service continue to
supervise the work. We agree that this will be possible and probably better all
around as thus they-e will not need to be two antimosquito services in Etaceio.
WAS and I make rounds of city rapidly to give him some idea of the topography
of the place, At 3:30 lmicosa arriving there at 7:30. WAS diagnoses
stegs,  culex and cimex in his bed,  Bald heads do suffer.   Almeida rel)ori;s that
he autopsiod a small child here about four days ago. (Althollgh in the known in-
fected district -tne history does not sound very s;jspicious of yf' although another
child died recently in the famillr.)  SvLyts p4LIrJ RC?oup Q/K /ep7?=5

June 22.  SUNDAY. Rather hectic day chasing around in the mud trying to find out how
      many mosquitoes there are and how many casns of yellow fever there haIre been

in Vicosa.  21 houses in R. Palhico c two steg-foci.  On house to house questioning
find many more suspeat cases in R. Palhico and find cases in R. do Cravo and R. da
Compania. The disease has apparently beenrather widespread except possibly right in
the center of the city where onl.y one case is thought to have occurred.Vicosa had
yf epidemic about 1890 and since then at intervals has had suspicious cases. Is now
a tom of 1700 houses and about 8000 popujhation. On June 6th the prefeito, one
Villela wrote to the governor that yf had b;,en confirmed by the laboratory $not true)
and that he estimated that he had lost  "24  municipes" from the disease this year;
however he still talks a-bout the lost 24,fifteen days later and we know there have
been deaths in -the meantime; when :Jressed for the data for his statement he brings
around a list of deaths by months diagnosed as "fever". Almeida is instructed to
;Z;et what mortality statistivs are available for study and analyze them.  It is of
course possible that this many deaths have occurred from the disease but the data
so far presented are far from convincing. The intendente is emphasizing his losses
in an attempt to secure from the governor an order for the prophylaxis rural which
is without budget for such an undertaking the establishment of a post in his county.

During the day we picked up the history of one case who T;Jent to Aqua Dranca in
the stbrutr&y of Palmeffa dos Indios from the focus next to the school; took sick on
second day after leaving Vicosa and remained in Agua Branca only four days re-turning
$e soon as he was able to walk. This case was proba.bly in Agua Branca during the
entire infective stage of a mild attack of yellow fever. Coy working at hotel was
only severe case in larse family where all were ill.
    Take Almeida to task for failure to clean up hotel block.  Discuss with him
his relationship to the service; he states that he is ?5lling to be trsns8erred to
other sta-te if necessary for the welfare of the service.

June 23.  Monday. Left Vicosa
       E!ieneschal;      6:20 am arriving Naceio 10:20. Long conference with
            discuss drainage problem again and also the need for routine
         -2romises of cooperation secured. (Discusses specificiQ of liver
         stateSthat Prof. Leoncio Pinto,

lesion to be'due to nest mortem channes!lll!!. pathologist in Bahia believes this
                                 having: produced  it in bot'n acute

alcoholic and creo1i.k poisoning cases by letting
for several hours before fixa-tion.)

      WM and I visit zones were oilers have been at work and find it hard to
believe that certain pools with large foci were oiled only three days ago. AJ.meida
and guarda chefe both* insist however that the oiling was done Friday but that the
heavy rains carry oil off so rapidly that the larva& are not killed. Find one large
backyard focus where the outlet is so arranged that oil would literally be skimmad
off thee-top by the outflow. Authorize another oiler for this district and insist that
the situation must be brought under control. The oiler is to be sup?lied from the
men who were on drainage work.


75 .

June 24th. Lv &ceio 7r30 am,arrive Recife 730 pm; see Sao Benedict0 enroute. SB
      is rather a small compact town very easily controlled if by chance the
disease has not already burned itself out,

     Receive lette-r from MEC enclosing -his l= lettain
which he suggested kmansion tomx&&or DO-! Newspapers report two cases
in Belem; one of these an Engli%%nan by the name of Chandler. Xire f ram PJC says
Chandler died June 21 clinioally yellow fever. Telegram received from Uchoa asking
for authority to open services in interior points such as Pompeu, Quirada and Oros.

June 25. PJC wires that Dr. Costa is doing vigilance work in the afternoons and that
     21 primary foci were found on Sunday June 22nd, 15 of which were in roof
gutters. Visit Gouveia with WAS and ERR. Talk autopsies and mv need for a uersonal
        office rool@readily promised. G greatly pleased with the new
orientation which calls for extesions to the interior. G has always been one of our
most loyal supporters even in the face of severe criticism although he himself has
never believed that yellow fever could be eliminated theough the oontrol of the
capitals alone. G pays a glowing tribute to the results of the service in Recife
and is happy to know that we pxpect to get the interior well under weigh% before
he retires from office in October of this year.
    Call on Tate of @era1 &;otors and get promise of cars at rock bottom
prices.

     Final conference with WAS more or less summarizing plans for the future;
notes on this conference taken by WAS who will prepare copies for NJZ'W YORK office
and for me.  In brief the outline is n s fOlZOWSj

MINIM&L PERSONNEL   REQUIRE%ENTS.

AXEXICAN                                     BWILIAN

General Inspector  Soper, Recife.
  Assistent     Bailey, Rio . i        Lit%&-    (Alvos, Rio)
Bahia          Wilson, SS, '        Sergipe
Pernambuco        Bickard Recife
          Doyle,Fortaleza)      Alagoas, Parahyba, R.G.do Rorte.
Ceara                         Piauhy  and Xaranhao.
Para         Cravflord,Belem)
(These are the principal key positions where men in charge will be located; in
addition a number of Erazilian physicians will be &myloyed to help out in the
larger capitals and in the interior.)

Director of Laboratory. (Davis)

Bacteriologist t mediaal man)
Bacteriolcgist Frobisher)
&~ri.de~-kiolog;ist; (J-i ~1 ti ::.>l1dies)

Assistant epidemiologist.

For administration purposes the nor&of Brazil probably best dtiided into sections
as follows;  1st. Bahia and Sergi e,
Grande do Norte. 3rd. Ce.ara,  t  2nd. Alagoas, Pernambuco, Parahyba and Rio
               Piau y and Xaranhao, 4th. Para and Amazonas.
Present plans call for immediate development of interior program instates of

section 2 beginning with the state of Pernambuco and working both ways from the
Cellterj this to be accompanied by an almost simultaneous development in Ceara
with the bringing of services in Eatal and Sao Luiz directly under our control with
full time directors.  First section to be held as at present unless something pops
in which cases develo;tment will be undertaken immediately; fourth section to be
held as'at present end to be subject to invest :C;ationaas soon as possible.
Program for pernambuco calls for work in all tovms of 2000 or over :?Jhich should
include practically all of th e county seat towns in the zone as far west as Aguas
Bellas and Rio Dr,anco; work to be&n on weekly cycle but to be lengthened and cheaped-
ed as fast as field studies warrant; probable that supervision can never be
maintained with cycle greater than four weeks. Places smaller tnan 2000 worked PRN


76.

June 25th. continued.  Investigations. The investigationa side of the work should
      be stressed; it is q!ito probab1.e that two quite separate types of service
will be needed, the one directly responsible to the control service for workins out
problems of local interest and running down local rumours and the other entirely
independent of state and sectional boundaries with no direct respobsibility to the
sectional directors but with freedom to go anywhere and study the problem in the
north as a whole.
    Proposed studies;

          Distribution of immunity in age groups in typical towns of
              four zones previously described for ijernambuco.
          Distribution of immunity in Amazon valley.
          Distribution of immunity in small town immediately following
               epidemic.
        1dappkin.g of  immunity distributions throughout north Brazil.
( All of which should keep us all busy for the rest of our natural lives if properly
carried out.)

.

June 26&h. WAS sails Arlanza for Cherbourg. G furnishes off e sn d aeain -:)romises
       help In ' terior. Deciiid to trv out the
e in the county of Nazareth where there are nine districts with as many local
escrivaes do paz; if results here are good the system then may be extended to
the rest of the state; if results are Poor something else may be tried.
         Rocha comes to Recife from Parahya to discuss the service there and
totalk about his leave; I am forceil rather against my will to talk harshly to him
about giving to Ceasar the things that pertain to Caesar;f%hdally relent somewhat
and promise to get him relief before the end of July but insist that he make up his m
mind now whether he wishes to return to our service or not after his short leave in
Sao Paulo.

       MEC sends copy of letter from lawyer representing the old employees of
the Malaria Service in the state of Rio who did not get paid after the month of
Sept; on the same mail comes the notice that the President of the state of Rio has
approved the request that the malaria accounts be paid from a special draingge
budget which is available this year.

         Advise Natal that Davis reports livers of IGCXEZ, MFRAXCISCA and PFELIX
negative.

June 27th.  Wire Rio to write ERR how cars should be billed for free importation into
Lhe port of Santos for the GMCt Dolye to remain with Cunningham week or ten days
and then relieve Rocha in Parahyba.  I get shot of local tylhoidaccine by mistake.
This is the second,

       Rickard says that shift of responsibility for the Recife service will
be made to Machado on Monday of next week.


                        \m
                                                   FLS 1930

Juno 28, Left Reeife at llr20 AM on                  Dr. Nellio Tavar
       and the new guarda ohefe in             e plane and repor
nothing new there; malaria continues           problem. The Paris green
sent up from the Rio office has been re       is being used on the river
side breeding places. Arrived %n Fortal      B1[ but landing was delayed
because of police visit.
      Dr. Samuel Uchoa, director of the State and Federal HeAlth Services in
Ceara, who has been directing the yellow fever service in Fortaleza since Karch;
met me at the landing. We spent the following three hours discussing the local
and n&ions& aspeots of the yellow fever situation. Dr. Uchoa is and has been for
a long time anxious for the service to be extended to the .interior. On June 23
after reoeivb@g confirmation of the Braquelais case from Maranguape, Uchoa wired
Connor asking for authorization to extend the campaign to include centers of
population in the interior and mentioned especially Oros, Queixada and Sen&dor
Pompeu and calling attention to the expected influx of foreigners with the re-
opening of the Obras contra as Seccas of the Federal government,  I explained
to him in outline the programme for the immediate future upon whihh he himself
suggested th?t no change should be made until after the arrival of Dr. Doyle.
On learning that plans had been made to send in a full time man to take over
the service, Uchoa showed me the draft of a telegram to 14% which he had expected
to send in the near future asking to be relieved from the direction of the yf
service because of the weight of other duties.
       The Xaranguape case csme in for considerable discussion; Uchoa finds
it strange that a single case could appear in this town with no preceding nor
posterior cases in spite of the heavy steg breeding encountered. I cite the
Estancia and Timbauba cases of 1928.as~exactly parallel cases in which the epi-
demiological inquiry failed to reveal other cases and told iJchoa that this is
the type of thing that has a?i)arently been going on for a Yang time in %:;' 3
"endemic" areas of north Brazil. I also cite the discoverv in Belem of two cases
          . .
in Bra,&&&@ children in widely separated zones of the city through routine
autopsies and the failure,to find any connection between these two cases or any
indication of the occurrence of othercases in the immediate surroundings.
      Uchoa brings up question of guards chefe for discussion; he feels that
there was no justification for the charges preferred against the guarda chefe to
Dr. Connor and that the man should not be-transferred Bs a punishment.  I reply
that anonymous letters never receive attention from me and that in any case the
question of subordinate personnel and their punishment if necessary is to be left
in the hands of the local director. 30 change will be made then before Doyle's
arrival who should be able to choose his own guarda chefe if the present one does
not suit.
       TJchoa insists that the service in Fortaleza is in good shape and that
the service in Maranguape was very efficient and veri rapid in its results; the
cooperation in Marsnguape was all that could be desired, a conto being voted by
the municipality to help in the work and regulations for the restriction of raising
pigs being immediately enforced. Loose hogs in the streets were actually shot
down by the local police authority.
       Received  telegrams before leaving Hecife:  from Rio stating that Rio papers
are copying alarming information from papers in Para and that presence of yf there
is due to insufficient personnel and material in our service and that Ambassador
Morgan has asked the government for official information regarding the dieease in
Belem; from Rio stating that a very suspect Portuguese has been removed to the
SSebastiao Hospital from the Cattete district in Rio but that the medicos in charge
have not made a definite diagnosis as yet; from Bahia stating that a very sus-
                             ::::a1 wired Wilson to investigate
                               y three cases are known to have
occurred in Belem including those d.i.scovered by routine autopsies.
       Wilson also wires regarding the purchase of the projector from Burke;
I reply that this purchase was authorized by Dr. Connor and that the projector
should remain for the present in Bahia.


                                                     YLS 1930
June 29.S mday . 1Jp at 4 in the morning;; to get away at six. Wo passent;ers
         and about thirty gallons of gasoline had to `be lef-t at
Fortaleza because of inability of the Sao Luis to rise from the water with
a full load. From the air it would appear that Araoahu and Camocim, Ceara,and
Parnahiba, Piauhy, are sufficiently kI;JOrtm% centers to merit consideration
on any extansivo programme of yellow fever control in this area. Arrived at
Maranhao about ten thirty and Para at 2 ?X. We had a good tail wind all the
way from Re8ife to Para and kept well ahead of schedule throughout the trip.

        Dr. Crawford reports r&her optimistically regarding the local
situation in spite of all the newspaper talk of yellow fever epidemic.  Since
July of 1929 only three cases of yellow fever are known to have been in Bclem;
one dying on the 16th of Nay and one dying!; on the 21st of May, both picked up
accidentally postmortem by routine autopsies, neither having been suspected nor
Bnorte& th
         .    e third, an kglishman by the name of Chandler died June 21st. The
liver examination report on this last case has not yet been received but from
history of illness duration of the disease and the macroscopical exalina-tion
of the body, yellow fever is believed to be the most probable cause of dea-th.
These cases occurred in three rather widely separated parts of the city and so
far as could be learned have no connection one with either of the others. Two
cases were in Brazilian children of six and seven years of age respectively;
on inquiry the father and mother of one of these cases (Lucimar dos Passos from
Val de Caes) both gave suspicious case histories for themselves but reported
not'ning for their other three children.(Dr. Crawford has already drawn blood
for protection tests on the father and mother and I am suggesting that we get
bloods from the three children to determine if possible whether the entire family
has not been immunized with the appearance of on)y one serious case,) No report
was secured for suspicious illnesses in the families nor associates of Edgar
Paria and Chandler.

        In checking over the two cases which occurred in May, Hothing
striking was discovered in the nature of stegomyia breeding in and around the
houses where the cases occurred; fourteen pup&& foci in roof gutters were found
within one block of the house where Chandler died however. The regular routine
service of the zone guarda was apparently in good shape.

        Crawford reports that the news items referring to lack of
personnel and wework of the guardas published here and copied in the Xi.0 press
were instigated by some disgruntled employees or rather ex-employees who
desired to make trouble; insiste that there is apparently no ill will on the
part of the local press and that no difficulty is encountered in get-ting any
desired propaganda ?ut before the peole through the press.

         Crawford believes tha-t the local stegomyia problem can be
handled efficiently without any great increase in personnel; all but one of
the servants on the ditching work have been taken off and assigned to the in-
creased roof gutter squads or put on vacant lo-t clean ups.  Hoof gutters and
vacant lot trash collections seem to be the special problems needing emphasis
at tile present time, The roof gutter pro.!jlem has been taken up with the govern-
or who .is quite ready to cooperate and adopt the same regula-tions as arennow in
force in the Federal district; he suggests however that for legal reasons this
measure should go on &te books as a regulation of the city council of  Belem.
This regulation has been dralm up and submitted and should be passed during the
coming week. Crawford reports good cooperation from both the state and the fed
eral health authorities in Selem.

June 30.  Call on Dr. Albino Cordeiro 018. the State Heal-th Service and Dr. Jayme
      Aben-Atha&.  Dr. Al'bino insists that the roof gutter regualtion in now
before the council and will surely be voted within the next three days. I ex-

we might have gone on for months without knowing of the  infection t\r;_tihout the
autopsies which he   s enabled us to secure. I then discussed the importance
of securing routin  autopsies from the interior of the state and exp&&ined to
                                         -
him the svstem nob 4 h use ln the&to of Rio de Janeiro through l!Jhich the
tolvnship clerks send in liver speci[:lens from #w#?a.;-ter less than


FLS 1930

June 30. continued.   eight days Ulness. As my innovation in any service here
             will at first meet with opposition, I suggested that Albino

and I discuss  the matter with the President of the state. Dr. Albino promised to
find out who is reqonsible for the cemeteries in the in-tcrior OP this state and
.throu& which channel we could best secure liver . s?eckzens and arrange for a meet-
ing with the governor on July 2nd.

                    Dr. Crawford and I thanked Dr. Aben-Athar of the Prophylaxis
Zural for tlie fine cool>erution he has been giving in the rna~tter of fines and forcing
the correction of roof gutters and in the examination of routine liver soectiilens in
&is laboratory. He assures us that he is vitally in-terested in the whole- problem
of yellow fever and that anything he can Go to aid the service will be done willingly.
We discuss fullv the vellow fever situation a s we see it throughout Drazil today
and call his attention to what is beinr done with rol?tinc $Lutopsies here an.; in
?ne states of X.0 de Janeiro and Zio Grande ilo Zorte. he tissures lie that he will he
able to secure autopsies for us in the following points xSAere he has services organ-
i z&J : ahT{QlJEfi   SC,! yam,;   C&,IhYA  Q!&ylijr;IpA I(&&p&*453U ~~&&,QjL`k   anci mFJl3s.
Cur service l;fi.ll furnish necessary containers anti will forward tile S~Jeci!!`WiS to
the dahia labora-tory for examination 8-s this rol.Ytine would really work a hardship
on Dr. AbenAthar who is hi s ol:m an;ltoijGst. Someho~w I havemmore ,"aith in securing
syecimens  Prom kilese vurj.o,x i~laces t;im I i5~ould have in case 903~2eone else had Imde
the ;,ro~~is e .

               j,j~.sc,.~ss roof gwLl;t~r pro'ulem -c&t11 2ravd'orti and su~;~es'k t; 1a.t -.qe inid
bet~ter <e-t ou-t an,d see what is happening in roof gutters where foci were found bne
two and three weeks aso as we hove at :?resent no infor ,,ation on which to base the
interval for routine reins;,ec-tions.
              Cra-&'ord stateS that he is entirely sat!.~;?icd  TJ~[ -I:; 1 -i;li e v:o rl,- of
Dr. Silva who is just now coni2leti.n~ his i'irst &ix iilonths of service;  I therefore
authorise a t~fo hundred milreis "er nionth Tncrease in his salary.

July 1.  B5si.t roof gutters of one two and three weeks ago; find some corrections
      made,  more not made. We +a'-e 'own seven meters of sop-g)ergul;ter in a
"repeater".  Crawford and I agree that 9% -.vould ~~robably be well to have a special
scpad to visit all roof gutters where foci have b+en found fifteen days after the
discoverjr of the first focus. Hoof g-u-t-ter breeding in Para will probably be a
gre n-';c 1' i~ro'ulem in -the dry r.zon-ths -than in tlie rc.i.ny season as there is tl?rou&ou-t
-i;lte year some r-air5 yrl~ic?~ ~i7.1 I,-eq ?.7ster in khe cu-t-Lers bu-t which will seldom
come down in sui?ficient quantity t0 flush them 0U.t.

      heceive w$re from "nio asking authori.:.at:ion to a.j~,co o:le ~ront'ns salary
-Lo 2. i:,ai>oel Lea1 Ferl*eira 1-i!lo leaves on July 3rd for the USA; authorize tllis RS
it had. ulrc~.dy i>een !?robliseJ. by Dr. Connor. Advise SaB Lois, Fortuleza, l;il.'cal,
iCeci.fe, &tll i-a, ~ahia*L$i tmd Xo of lq'schedule till the 15bh of July.
     Dr. Crawford and I visited the house where Edgar Faria, the six year

old Brazilian child, living in the city of Belem, discovered to-have had yf
throu.& routine autonsy on kav 21st. died. The house is one of the peore7
%ype structures of one story but is outside of the heavy malaria zone. At first
the fsmily insisted that there had been no other cases of illness in the family
but when they discovered that our intentions were of the Best and that we were
k-kerested in other than fatal or nigh unto fatal illnesses, they admitted that
five of the twelve persons resideing in the house had suffered from attacks of
fever, headache, bodpains and vomiting between January and June of -this year;
these attacks \vere sufficiently severe to cause confinement to bed for from four
to thirty days. From the history p;iven, I believe malaria can be ruled out in

these cases and am c-inced that-there were probabxa series of cases in this
      ut that because of large number of immunes in surroundlrq houses or
        er  of stegomyia serving as vectors
                          -        me wasmrently no local ex-
    of the d1sease.S we later vlslted the house of Lucimar Passos in Val
   but were ablx obtain no further information than that already noted
June 29.