T                                             FLS 1930.
J 2.  Davis wire8 that Hair liver Vioosa hlagoas negatives this ca8e wa8
     autopsied by Almeida about June 18th~ wab young ohild without
m oal history but living in known heavy yf foous. Almeida notified.
      Wileon wire8 regarding Barr08 Barreto account; reply that account
8hould be charged through the laboratory to be paid entirely by the RF.
       vi8it ten house8 in Zone 51 with the guarda and Crawford3 one
steg larval foc~a found in barrel; nobody complaining of carapanas now but
several state that 8014~ time back there were many mO8qUitOe8.
       Dirrouss with Dr. Albino Cordeiro the possibilitv of autousie8 in the
interioahe skates that the problem will be very difficult to solve and that he
personally believe8 nothing w be aocomplished exaept through dootors of the
health aerviaes or through doctors who also happen to be intendentee of the
oounties where they live3 nothing is to be expected of the tabelliaes(registrar8)
a8 he ha8 never even been able to 8ecure from them reports on the total number
of death8 occurring in their diutrictsl  Then too the people of the interior are
very ignorant and are very superstitious regarding the bodies of their dead; all
in all, it is palin that he advise8 against the making of the a#tempt to secure

                        the disease exists
that the disease ha8 aither hung arouM in Belem since July of 19a9  or else ha8
been subject to exportation end importation since that time. (Of. course both
hypOte8e8 may be true at the lame time.)  In any case for the future of the control
work it is important that we know how much of the disease exists in the interior
of the state. Dr. Valle gets the idea immediately and suggests that we oall on
the chief of the state police in'his name and ask for cooperation end suggestions
as to how`suoh'a service can best be organized in the interior.
     During this conference with the president, the question of. calhas,is
ventilated quite thoroughly; Ev reports that the measure is being forced through
a8 'a municipal one which is where it should be according to the division of pre-
rogatives3 he insists that the measure should have been presented to the Mun&&ipal
Council yesterday; the Secretary of state sqrs thr.t i-!; L.c '-0 be i'rol~ght up for
vote today.
    Call on the ohief of the state police who is also judge rn Braganca; he

from the seat of registry end often '-1 have occurred several days before being
regiateredi this most logical solution of the problem then which would appear tb
strike the source of 8upply is not to be recommended. The tabelldio also is not
directly subordinate to the administrative arm of government and would have to
be handled through the judiciary. 2nd. Through the 8ergeants of the state polioe
who are to be found in every distrirthese men,however, have no direct oon-
nection with the mechanism of burial except in special criminal cases and are in
many oases entirely illiterate hav&ng been chosen only on the b-is of their
ability to dominate their personnel and their districts. The only advantage in
using them would be that they are ubiquitous and under direct oontrol of the
uhief who is willing to help us inaevery way poaaible. 3rd. Thro    the   tend-
entes or loosl oounty administrators; the intendente in x p aoe
                 Yi--Yi!Si%p+!!&zea-
by the govenuF a8 Ene looti representative.of the state government and is very
sensitfve to the suggestions made by the state.


1                                                 FLS   1930

J   2. continued.
+        The intendente has under hi8 direct aontrol the adminis-
      trators of the cemeteries who are generally very poorly paid and
should be willing to take a real interest in getting liver fragnents$or a
8mall premium per fragment. The ohief recommend8 that we first try for livkrs
through the intendentes.  I accept the suggestion but insist that the attempt
be limited to one or at the most two oounties until the routine 0811 be worked
out. Dr. Albino indicate8 Vigia whioh lie8 between Belem and the Atlantiu on the
rieht bank of the Ama8on a8 a good place to start a8 it ia aooeaaible and is

prgbably the most  or-tan-t point of departure for the amall boat trade covering
l&e coast north 0   e Amaron. Actual detail8 Of Organieation are le f%Tz---
?'uture determinati on. r. Crawford will probably go to Vigia to arrange detail8

with the intendente.

-

Mote8 regarding dis&xssion of looal problem with Dr. Crawford during the last
four*. days;

      Medical Vigilance.  PJC has been using one of hi8 doctors in the after
noon8 to`ahe& up on the alinioal histories of reported death8 whioh from their
diagnO8e8 might be thought to have beendue to yellow fever. I suggest that this
iervioe be disaontinued a8 8oon as aonvenient irltiout letting the local authorities
and our own personnel know that the diaeontinuanoe wa8 suggested by me.

                  our programme. When pressure 18 brought to -
bear attent                eophilo Torres' report on the Fabrioa das:
Chitas epidemic in 1907-08, the last epidemio in Cru6'8 time in Rio. Torree inc
sists that the direction of spread of the diseare wa8 influenoed by the direction
of the prevailing wind8 oar-g infected mosquitoes driven from infeoted hOUSe
by fumigation always in the same direction. Similar relaiA&mhip ha8 been claimed
for oases occurring in upper and lower cities in Bahia.
      lbcidents to aployees.  Workers injured in the line of duty may.be
sent to the Assistenaia Publioa and treatment paid by yellow fever service. Prefer
that Dr. Crawford take no part in treatments.
       Potifioation of Yellow Fever.  The yellow fever service should always
notify looaf. health authorities of both the state and the federation; newspaper
notification8 should come from other souroes. ( The two accidental oonfirmationa
of May were notified by PJC to Dr. Albino; the governnr of the state suggested to
Albino that the oases be not reported.)  Should take into due consideration the
diagnoses made by Dr. AbenAthar but should always submit specimens to Davis for
oonfirmation.
        Classifioation of Guardas.  Suggest relatively small difference be-
ween salaries of guardas of different olassesi probably 2200, 240$ and 250$
would be reasonable basi8) focus found.behind guarda by GC to be counted against
guarda for classifioation only after verification by doator or guarda chefs geral
of the service.  Focus b&&vi guarda 'GO be 0)~1-?--~-? ?iLy if found within 36 hour8
of the time of hi8 visit.

      Classifioation of Guarda Chefes. I fail to approve this idea. GC is
in responsible position at higher salary and is supposed to know his job. Suggest
more rigorous checks on s
defects in theer service;
classify but fire for  in
       Increases in personnel.  Should be made only after due authorization.
All American direotor8 will be constantly informed of my whereabouts by telegram.
Authorization at present time is made Bar appointment of guarda ohefe to direct
and check work of the gytter squads; for increase of office personnel to permit
of all strictly routine work being done by subordinates, to make block indices
available on foliowing day. Also special clerk may be hired to keep file of


                                                  FLS 1930.
July 2. continued.  legal notives and fines,
     Distribution of Fish and Sealing of Water Boxes. As both Uuench and
Crawford believe that the institution of these r'easures which are expensive
would not greatly better the $eoal situation, it is suggested that eduaational
means be attempted to get deposits fished and water boxes sealed.  Fish will
not be furnished here but are so readily available on all sides  that no one
should have diffioulty getting them, In the meantime, first oiling and breaking
and then fining is to be folbowed out in repeating foci.
      Station Journal. Only one station journal is to be prepared in Belem.
The doctors working under Crawford should submit to him whatever details of their
work he desires; important points in their reports or regarding their work may
be included in the station journal. The station journal should be limited to
relevant information; oorrespondence and telegrams need not be copied except in
so far as it is desireable to insert verbatim instructions or vital information.
It should be remembered that the station journal is a Station Journal and is
neither a personal diary nor a narrative report to the central office; any matter
requiring action or discussion by the central office may be mentioned in the
station journal incidentally but should also be called specifically to the attent-
ion of the director *special letter oovering the point. The station journal is-
intended specifically a& a running hi8tOI-y of the Sme for the future Orientation
of the director on all important points for which he would atherwise be forced to
depend on memory &d for the orientation of possible future directors who have no
first hand knowledge of the situation.
      Sick Leave.  Employees reporting sick are to be investigated by the GCG
or one of the medicos. Raoh case should be judged on its merits and pay continued
in judgement of local director up to maximum of two weeks.
    Mother Foci and Breeding Roof Gutter Oquads. When daily information on
steg indices by blocks is avallable, special. guardas may be detailed to work dirty
blocks to discover pupal foci.  A special ladder gang is to be detailed to -the ex-
e&nation after fifteen days of all roof gutters found breeding on previous round.
    Stamping of receipts for paymenta. Up to the present time the business
house8 of Rara have refused W sign dupxcate and other copies of receipts without
affixing revenue stamps to such copies. In the past two copies with stamps have
been submitted, one for the government and the other for the RF account8. The
other copies that must be filed in various places are nothing more than the account8
as presented and carry no notation to show when, if, and to whom paid.  suggest
that a rubber stamp be prepared oarrying the declaration to be signed by the house
that a receipt for payment was signed on eugh and such a day.
    Numbering blocks. Suggested that blocks be numbered on the four o&ers
with arrows indicrating Ehe itinerary of the guarda and the number of the zone.
3 UL Y ,3*  70 FFc - .mrl~ t-9 +A &)/Z.


FLS 1930.

July 3rd.  After discussion of local situation with PJC, suthorisnd the
                                            .
      following ingreases_parsennel.  office staff, 2 if nt3cessapJ;
gutter gangs, one guarda chefe, one guarda, 2 serventes, 'these squads
of 5 men each, now working on vacant lots.  This number can probably be
)eduoed, after the first time over;  one man now on ditches and G men in
districts '7 and 8 is one lesseach serventes working with the guarda))
mother foci squad, one guarda.
July 4th.  Arranged with Dr.Albino for our men to get the keys of empty
      houses at 4 p.m. one day returning same at 2 p.m. following

day.  PJC and T visit vacant lot squads and find excess of zeal in cutting
trees and slack work in collection of water containers. Sail at midnight
on Itapk for Rio.
July 5th.  On board ItapB.

July 6th.  Spent several hours in Sbo Lm Dr. CM and guarda chefe
      report everything in good shape with recent emphasis on preven-

tion of gutter breeding.  I explain to C!&! result of routine autopsies in
Eelem.  He promises to secure in the near future 30 or 40 autopsies frog
_S~i.o_LuJz. Fe is not so hnoefill about aut
ve
                               oosies from the interior. Ila
conference with Dr.-Pires &all Director of Prophylaxia Rural for the State
of Piauhy, with heaauarters in Therezina.  Dr.Leal is a brother of the
Governor of the state of Piauhy e.nd has been bringing pressure to bear
during the past year to secure a yellow fever service for his State. I
have promised him such a servioe just as soon as he secure a positive autootv
  yellow fever.  Dr.Leal has
i,"ly 7th. On board Itap6.   not heard of any suspect cases in his State.

July n Lunched Fith Dr.Uchoa.,. FTe reports local situation un-
      changed. SU is anxious to be re&ed of the responsibility of the
yello-.~ fever service.  I suggest Doyle will b: able to take' over about August

iOth to 15tk.
July 9th.  On board Itape.

                  v for
able and shaa reduce

July 10th. Recife. Dr.Rickard demonstrates first..work% model of ins&w
        rem0 * rr liver section.  This modeXapoears pratic
the dangedction-of persons securing tissues and should make the onera
more acceptable to the public.  ERR reports satisfaction with new forms but
suggests waiting longer before general adoption.  Wire Dr. Rocha requesting s

tion

tate-

ment of future plans.
July 11th. On board Itap

July 12th. Bahia, Saw                                    Dr.Fernando
        Luz.  L!y im                                 ham be sent to
Aracajd not later than July 15th.  Secure list from laboratory of people in Mag&
from whom further blood specimens are to be procured.  Davis and Shannon returned

They believe Ilheos infected. (1~ _: ;L i&y,,,,.,\
d Itapk.

July 14th. On board Itapk. Arrived Rio 7 p.m.

July 15th. Day at office largely routine.
Bahia. Probably influenza.   DB?Y reports suspect cases in Spaniard,
                   (Later July 22nd DBY reports lung consoli-
dation), probable diagnosis influenza pneumonia.  Conference with CF. Quite frank
statement to CF of difficulties of situation in North.
-~&g                          Repo_rted opinion regard-
        CF very anxious for immediate steps.  I reply l,ilson has been authorised
                                            '-%r
        te control me"sures there as soon as laboratory report is available,
but that I see no reason for precipitaeed extension as far as Rio de Janeiro is
concerned, because it would appear that the yellow fever virus has been present


FLS 1930

in Ilheos at least since January,
           -h ..~_              furthermore this is the least favourable
                    L___- I
season df the y&&$-for development of yellow fever in Rio.
~'aldsmar Rocha cables resignation from yellow fever service   4
July 16th.  Registered garage transfer with the police. Dr. k- It"-//
                                               aranhos comes to

        office and reports activities in New York.
July 17th.  To Oswald0 Cruz Institute to discuss situation with &-a&o. Spent
        the evening l:rith Araggo and R-Lima discussing various phases of
yellow fever work.  Secure promises of white mice from both Oswaldo Cruz and
The Biological Institute in Sbo Paula.  DB?'Y cables sugkesting Dr.'Lima Netto be
relieved from service in Bahia: Release aoproved with payment of one months'
salary.
July 18th.  Presented report of yellow fever service for May to CF. Called on<
    S.Lima and discussed local situation with him. Call Dr.Ferreira.~~ti.l:.~~~
Pinto regarding samples from Mage but learn his sisters' illness will prevent     ,,
'his working in the near future.
missing both boat and train.   Cunningham finally left for, Aracaj6 today after

July 19th.  Anderson of Standard Oil offers services of oatent attornev for
$       making out necessary papers on&sue i invented by Rickard.
Doyle ordered to proceed to Bahia and thence to Recife immediately. Conferenae
with CF who approves Dr.Bodrigues porta to Recife, Dr.Jo&Cesar Oliveira, Fortaleza.
Dr.Sraulio Furtado Luz, Rio. These men will be hired im$'ediately as well as Dr.
Virgilio Oliveira and Dr.Couto h@er in Bahia recommended&y CF. Ratify CF that
I shall move my headquarters to
July 20th. Sunday.       Pernambuoo in the near future.

July 21st.  Receive at Treasury Rs.17:323$978, various accounts. ?Yilson reports
       133.~0 en route to Rio on Prudenta de ?&n-&es. Davis reports virus from
6th mouse passage killed monkey y.f.
'July 22nd.  Lunched with Decio Pnrreiras, Director of yellow fever service, State
            of RIO de Janeiro.
ing our results in Magk:     Authorised followirq; statement in his report regard-
              "Mage studies indicate more immunity than yellow fever".
Our results are not ready for publication and probably will not be for some time
yet.  DP calls attention to fact that yellow fever in 1928 and 1929 was limited
mostly to zone flictheroy, Rio, Rezende, whereas 1931, yellow fever has been found
in !:Iage and Cantagallo to Campos zone.  Admits yellow fever in following places:
Between April 1st and June 3Oth, 1930 - $&.&e(Mage), Portella, Tapera (Campos),
Itoaeara and Cantagalla.rn addition he states confidentially that tissues from a
positive case 'T7FGGGity of Campus, arrived in ?Jicthe:roy today.  DP and I discuss
                            f routine autopsies.  I sumhe publish
                                    DP refuses to publish on own
authority.  Discuss  the difficulties existing between Health service in the State
of Rio and National Department of Health. However, he promises to furnish me with
  w
details of his service and results to be included in a note in "0 Saneamento".
bP states Dr.A.Luz is now working in k&age. rrornises full cooperation in securing
blood specimens from Mag6.  DP reports that Cantagallo was diagnosed from analysis
of death certificates and entire town had been fumigated and entire larval service
organised two days before first clinically suspect case was reported by local


July 22nd. (continued). Call on LirZdwurds, i:.anag;er of the 14yrba of Brazil, and
      discuss method of securing rebates on passages. lL;r.idwards promises to

send recognition cards for our use.  uie discuss quite frankly the possible rela-
tionship of air passenger service to the spread of yellow fever and I suggest that
the air Companies should be very much interested in the control of the disease as
quarantine measures instituted among air passengers would most certainly kill the
air passenger bushess.  Incidentally I suggested that the cost of passages for men
in our service should be further reduced.

July 23rd.  At my request Z)r.Henrique isagi%o came to the office for a discussion of
      a special yellow fever cor;mission suggested by I)r.Connor to study the
yellow fever situation in the North and make recommendations. This co~aission was
to have been appointed by Ur.b'raga
                          -     at I)r.Connorfs suggestion and &ILL reports it
                                      __z ._-. -- "c.----- _...
would probably have been composed of Dr.k*aldemiro de-0.liveira of SAo Yaulo,Dr.Thomaz
                     -__I
hives and hir%ek<*with pr%%ly%%-&~er as yet undetermined members.  H&and I
discus'&-qwly the possible utility of such a comission. HA sees no pos-
sibitily of the report of such a commission influencing the betterment of water
supply systems in the North.  Under present economic conditions the Federal Govern-
ment will be unable to assist in bettering local water supplies even -if such a
measure were possible politically.

      I point out to HA that we actually have at present four m
oming in tiat maA be considered possib                     .
                                    nentmlc areas* namely the
D.fi1.S.P. in the E'ederal LEstriot, the Prophylaxis kural in the State of Rio de
Janeiro, the Prophylaxia Plural in the State of &inas Geraes and the Yellow Fever
Service of the Hockefeller Foundation in lu orth Brazil. Furthermore it would
appear that the State of Esyirito Santa, lying bet%een the dtates of Bahia and Hio
de Janeiro, is without any regularly organised Service. mible benefit
I can see for such a commission might come from the Colmissionss development of

a programme for rettlly united control of thsellow fever problem.  In order to
                                  -
secure such a result however,                      1
                   in the existing political conditions, the Commission ;

-

would have to be endowed with more authority than could be possible if organised    I
                                                                           ;
and appointed by T)r .Frsga.  Nothing less than a congressional or presidential       i
Commission could give the desired results.  The appointment of a cormnission as was >
suggested would probably lead to a report full of recormnendations regarding methods ;
of control which might very easily serve as a basis for unnecessary criticism of    ;
existing services. I tell l2r.H.L that I shall discuss the Commission frankly with !
Dr.Pr@ga in case L)r.Fraga brings up the subject but that otherwise I shall not push :'
the matter.                           _j;

      ILli believes E'raga will take an interest in case he continues with the
Health service under the new Government in I\iovember, mainly in yellow fever and an
Institute of hygiene to be established in Hio de Janeiro.

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

Hickard reports suspect autopsy Correntes, Pernambuco.

     Doyle left W &racaj< i2nd. July.  Cunningham's request for special
guarda for intbiation service, referred to builson.

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

Doyle sails for Pernambuco.

      Discussion of' yellow fever epidemiology with Drs.Lessaand Jansen. I point
out importance Of recent findings in State of Kio de Janeiro and North Brazil and


FIS 1939.

stress imoortarice of routine liver examinations.

    b;ord received of death of Dr.Theodore F2Kap-e from yellow fever, at
Lagos with onset 11 ~$?'_t_er_inoculat~une sera.   ?
            _ Me__*               ._ -.                            D

      New York office advised regarding Ehtdget needs for 1930.

July 25th. Biao arrived in Hi.0 from field trip investigating Sao Pranscisco River

       zone,State of Bahia.  He collected bloods for the laboratory from
several points;  found nothing suspicious in zone and secured no histories of
suspicious cases with the exception of two cases in Barra occurring in 1925 or
1926.

       BiEio and I visit Usu;aldo Cruz Institute and arrange for necessary
sterile supplies for collection of' bloods in ;Eiag& and also arrange for more white
mice to be shipped to Bahia laboratory.  Called on Eraga and bifio reports on Silo
Francisco trip.  CF promises to arrange for exhibition of the new yell@:r fever film
prepared under the auspices of the Health Department for m$r benefit. CF agrees to
come to our office on Tuesday,July 29th for a more complete discussion of the yellow
fever problem than is possible in his office.

        Learn from confidential sources of suspect case from >1ict,heroy in
Hospital (case visited July 26th; somaihat jaundiced w-ith positive diagnosis
malaria.  aother suspect case died yesterday; autopsy diagnosis Pyelonephritis,)

Health   The Governor of sergipe ctn;les aggressor fined 500;Y;OOO by State [~[h~y
    service and faces further prosecution criminal courts.

       Fraga on learning of death of Lr.Hayne in drica, suggests Foundakion
use brazilian personnel from endemic areas.
July 26tg Ur!k!rz'
                7
          . .     , professor of hygiene, iiiedical School in hictheroy spends
      morning at office

Bi.&o and I secure material for hag; from Institute.

July 27th. Sunday. Biiio and I spend day at Ma&; secure 15 bloods for repeat
      examination by laboratory.  BiEo will continue this v;ork alone after
today.


                                                         FL3   1930.

July 28th.  The politic4 situation is somewhat comp!.icnted by the v (July
     26th) of Dr.J~?-@3oa, the President of the State of Parahyba and the
v-ice-President of t=position in the recent national election of March first. Redife
where the assasination occurred and Parahyba are both reported to be in a turmoil.

July 29th.  Attended funeral of the sister of Dr.Ferreira Pinto.
      Dr.&-nest0 Para.n.hos discusses Mayo fellowships.
      The reoent suspeot case designated for mnt of better information - es
"Correntes X" came to the notice of the Public Eealth authorities through a police
request for autopsy.  Death had been so sudden and unexpected that
ed. (this case positive NCD). Correntes is in Pernambuco epidemic zone.
     As arranged last week Dr.Praga came to the office today for a discussion
of the yellow fever programme in North Brazil.  I outlined for him the programme approv-
ed by Dr.iifamer; I stressed particularly the value and need of Feneralised autopsies
throughout the yellow fever area.  CF agreed to issue special decree or authorisation
to 130 drawn up by us to facilitate workinp with local authorities in the North if
difficulties should arise regarding autopsies.  CF requests another copy of annual
report for 1929 alleging that previous copy submitted by Dr.Connor has disappeared from
his files.  I notify Dr.Fraga definitely that I expect to transfer my headquarters to
Recife.

      Brought up question ofCaounFfiaio~~~~+b~.,Dr&annor for discussion
which was very brief.  CF agrees with me that there is no occasion for such a Commission
at the present time.

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

July 30th.  Drawings of new instrument due to arrive today, were not received.
      W-red Dr.Cunningham that only financial matters %o be taken up directly
with this office; everything else to be referred to Dr.Mlson in Bahia.
      Circular cable sent advising all posts of my proposed trip to Recife August
4th.

      Box of 70 white mice received today from Rocha Lima in SBo Paul0 which I
shall take to Bahia for Davis.

July 31st.  Lunched with Dr.Thompson Cotta, Mrector of the Assistencia Hospitalar.
     Lunch given in honour of Dr. C.C.Burlingar;e of the New York Medical Center,
who has been to Uruguay at the irrritation of the Uruguayan Government to advise regard-
ing their medical center.  Dr.Burlingame was particularly interested in what has been
done in Brazil in the development of the nursing profession.
      SU advises Dr.Jo#o Cesar sailing for Recife August 4th. from Fortaleza.
      F':ired Dr.Rocha suggesting he await me in Recife.
      Suspect case reported from Par6; J.Kislanov, recovered. No alhuminuria.

August 1st. Mr.Robinson, of the Brazilian Land and Cattle Company, called and reported
        much ma1 de oadeiras at Miranda.  Requested further information regarding
the use of Tryparsarnide.
        tnformation received Parah ba
                   Y  service has been unavoidably suspended be-
cause of excitment due to recent assasination of Pessoa.
       Dr.Rickard cables liver instrument gave good results on recent cadaver,
Poor results on 18 hour cadaver. Decio Parreiras sent me dra;lring of liver punch dated
                                               . .

-
July 12th marked Wclichd para 0 Saneamento". AA advises hot-iever, that such punch has
never been constructed; that today he overheard orders beinr p,iven for construction by
Lutz,Ferrando of liver punch along lines of Rickard model described bp me to Dr. Decio
     - ^- -

Qn July Z%nd.

Rickar_d'.s drawing not yet rece-ived.
          I-- -_ -_- . _.        Am wiri,ng .todaar- for duplicates.
     jayments will surely be made T:ithin next 15 days.  I refuse,how-

  _/- -- -
AS. reports F

ever, to leave signed check to facilitate the pay-men?; during rn% absenbe.  AA reports he
has been made direotor of the yellow fever service for the first district in Nictheroy
rr!it;hout increase of salary.


                                               PLS 1930.
August 2.  Letter written to DP asking for working model of his liver punch since
       he submitted with themnps no notes regarding results obtained with

       Drive to Institute to secure another seventy,mrather fifty, mice to be
taken to Davis in Bahia. This makes a total of 120 available including those rec.-d
frcsn Rooha Lima this week.
      Arag&o transmits Chagas' request for used monkeys for other laboratory
experiments.

August 3. Sunday. All day at the office. Translation of WAS letter for Fraga end
       quarterly yellow fever report.

August 4th.  Telegram 'from ERR anndunces drawings are to arrive'on Arlansat Arlenza
     arrives at I em and by dint of 'special influenoe' the drawings are secured
frcm the postofeioe at 3pm; hurried consultation with Rumpstone and Anderson and
lawyer of Standard Oil*                                 in name of Dr.
J. Tomaz Alves, since I

        Meet Captain Yancey of the USA to Italy flight.
       ConsuWation with Shobinger regarding gutter construction on the large
-new shops of the Light company in Rio. Estimates -proposed alterations will cost about
one thousand dollars.

         BiZie reports securing only forty more bloods during the week; however,
this may not be so bad since the group to be bled in Mae;6 is now limited whereas last
year we were bleeding everyone. Gave him additional list of subjects to be bled and
arranged for more sterile material from Manguinhos.
          Woman physician from school hygiene section of S&o Paul0 requests
RF fellowship; would be satisfied if RF would pay passage money as present salary
could be continued from Eellth Service. Promise to discuss herecase with Dr. W. de
Oliveira although she knows the fellowship service is already showing a deficit.
         PanAmerican Airways Company's representative calls .a11 worked up
over a cable received from Miami ordering to-day's plane leaving Rio tomorrow not
to touch in Par& beoause of yellow fever epidemic there; discuss c-uito frankly the
actual situation in Par& and give him statement that no cases of yf have been con-
firmed for Par&  since the 21st of June; wire PJC to give similar statement on
arrival of plane in Be&.  I take advantage of the moment to impress upon this
representative the .importance of yellow fever control to the air transportation ca
companies who have only one product to sell, viz., speed;  five or six day quaran-
tines would of course spoil everything for them.  Suggest that PanAmerican planes
be available for my travel even though they are not yet carryin
         Before embarking on the Itapag6 (Capitan Parry $ pasCemgers.
                                       at 4 PM, ccmplete

translation of WAS letter and autonsv decree for signature of Fraga.
        Dr. Bra&o Lue arrfved Bahia July 31st.
;5;;.
Ay;;    On board Itapag6.
P     Meet Dr. Guimarags, State Superintendent of Public Instruction State of
       Bahia. Speaks English knows the US and should be of assistance in giving
information regarding the interior of the state of Bahia.
7t@
August     Met by Wilson, Davis and Shannon. Call on Frobisher who is having his
       third or fourth attack of'yellow fever'; Davis refuses to take these
attacks seriously anymore. Onset Sunday August 3rd, with very definite headache and
body ache$ some fever and possibly some disparity between temperature and pulse;
slight albuminuria on third day and slight icteric tinge to solera today.  Feels
quite weak and listless.                                       .
        Delivered to NCD following material;  70 mice from SBo Paulo, 50 mice
from Rio, one box of sera 3rom the Scan Francisco trip of Bide with included list end
one box of sera from Mag& with list.

        NCD reports that the previous batch of mice brought from the Institute
were infected with mouse typhoid and that this mouse typhoid is capable of simulating
the pathological p-icture of yellow fever in mice including black vomit; in attempts
to filter out the offending organijsm from preparations of mouse brains it appears
that the virus has been lost after the twelfth passage; NCD suggests that time can be
saved secure mouse strains from NY; following wire sent," ROCKFOUND RIO SEND NIGHT
LETTER NH YORK QUOTE SEND DRIED INFECTED MOUSE BRAINS SOPFZ@
       NCD reports Description of Male Genitalia of A. minor sent for


tiepartamsnto S.i?~blica.

"ITOTITE DO BRAZIL
  A

,                                `..
                                  j . .

Recentes experiencias em dir'fererztes lo,:*alidades do norte e  `.I

sul do Brazil tgrn demonstrado a necessidade de autopsias systematicas nas        3
                                                                           I

regiges endemicas ou suspeitadas endemicas de febre amarella, corn o proposito /
                                                        /

de 2escobrj.r a presenga de cases dissimulados desta doenr,a.

  ,.)'
,

Rconselho calorosamente 6s autorj.dades saqitarias, aos clini-

cos e a todos que se interessam qela extincqgo da febre amarella no Erasil,

que promovam e *facilitem autopsias em cada7eres de pessoas que terham falle-
                --- --.-..NBb- --\_ _ \ -. -..    . .

cido corn zenos de riez dias de doenpa se2 assistencia med4?a, e corn symptoF:as
I. -..                                                    .--'-- -..

febris.  g vma medlda de ma-<ina relevancia que a actual adrqin: stra$go sani-

taria nacSona1 desejn faciljtadr por todos ?lle de qual?ller mod0 wssam con-

correr para t& Fatrioti.co object!vo.

Ilio, 11 de A;;osto Ge 1930.

(assign.)   Cleme:: ti.70 FrP.;a
               _____    .".--P

      Xrector (iera do
Departam~?r~f;o :iccional de S.Publica.


FLS   1930.

.A,.`. : gust 7th. Continued.   publication at least one year ago.  I therefore wire
I.

       Dr. Costa Lima to that effects Description male genitalia A. minor
i-as already been submitted for publication.

        NCD reports serum of Tobias Printsak of Natal failed to protect monkey.
This case was seen by Drs. Sawyer. and Connor in June and considered quite suspicious!
        Long incubatibn periods of apparently thirty days have been recently encoun-
ter&d by NCD in monkeys in the laboratory. He believes that all possibility of cross
infection can be ruled out; NCD was until quite recently very sceptical regarding such
long inc&ation periods but is not convinced that they do occur at least in monkeys,
Such lengthened periods are not necessarily associated with mildness of the staain as
one animal at least died suddenly and unexpectedly on the thirtieth day with typical
lesions of yellow fever.

        Discuss question of NCD'S and DBW's leaves due next year; assure both of
them that everything possible will be done to let them go on schedule time and that
the general policy is to get all personnel on leave from this field when due.
        Inquire of NCD policy regarding the disposal -5f uded monkeys; none aee
being allowed to leave the laboratory alive excepting a few that have been ceded $0
otherscientific institutions  for specific studies. He agrees to ship a dozen rhesus
to Chagas at Manguinhos as soon as available.
        Davis, Shannon and Wilson are requested to always shit expense accounts
pramptly;trotbe in my hands not later than the end of the follroPing month.
        Learn that contrary to Davis publication he has since been able to secure
transmission with a small percentage of taeniorhynchus; this brings up the problem of
their control especially in AracaJu and Maoei'a.
        SHANNON TRIP TO AMAZON. NCD brings up Shannon trip for discussion; Shannon
called in and following details learned2  ME% submitted Shannon's proposals to FFR and
the "Amazon trip" was approved whereas the "AMAZON MOSQUITO STATION" was left for future
consideration; according to the copy shown me of the proposal to FFR the Amazon trip
provided for leaving the laboratory in October with arrival in New York about the .l'.irst
of January which would mean a period of three months maximum including travel time from
Bahia to New York. As the proposed trip has been altered because of changes in the per-
sonal plans of Shannon, I suggest that a more definitely detailed plan be submitted to
FFR for approval. After discussion with NCD and RS the following was outlined as a
reasonable estimate of the nroposed trip;
                        Shannon to leave Bahia about Sept. 15th, to

spend five days at Fortaleza, five days at S&o Luiz, five days at Therezinha, thirty
days at Iquitos, fifteen days at Manaos, seven days at Obidos, seven at Santarem,
seven at Prainha, seven at Breves, thirty days at Belem, returning from Belem to Bahia.
In addition approximately  fifty seven days will be needdd for travail on the round trip,
so that a total elapsed time of one hundred eightyfizrw days may be estimated for the
trip. In other words Shannon would be away from the laboratory from Sept. 15th to
March 20th.  Shannon states that present indication s are that the government service
(Bureau of Entomology) to which he is attached will require his services July 1st 1931.
        NYRBA COURTESY C.ARDS delivered to Wilson, Davis, Shannon, Frobisher, Car-
doso and left. with DBW Cunninghamg.

        MATERIAL FOR ALBB sent by HAra@o given to DBW;card left for ALBB.
        ARACAJU situation discussed with DBW; advise him to visit Cunningham as
soon as possible/

         FUTURE EXTENSION OF BAHIA SERVICE discussed with DBW; Advised to begin
freeing himself from the detail work on city of Bahia service; should become familiar
with population distribution and with methods of transportation throughout the state;
should look up records of previous work of yellow fever service in the interior; increase
in number of apprentice guardas authorized looking to the training of men for the interior.
Calha work should be continued as at present; turma de matt? rang may continue as at
present as the present squat keeps the truck constantly busy.
           GENERAL PROGRAMME FOR NORTH as outlined in WAS letter of JULY 3 rd
discussedwith DBWL Promise to return as soon as possible for a thonough inspection of
the Bahia service.

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


FLS 1930.

August 7th. continued second.  PARAHYBA DANGER mentioned by DEW; I point out that
      this danger has been duly reco@.eed for some time but that conditions
have been such that even definite information regarding the situation has been diffic-
ult to secure and that last week our service was  forued to close temporarily in the
capital city because of the local disturbance due to the assassination of the president
of the state. The Federal Government is now coming into the picture and is concentrat-
ing tsoops at the frontiers of Parahyba in both Rio Grande do Norte and Pernambuco.
      AI&MDA WIRES SUSPECT YF PIHDOBA three leagues frcm Vicoaa; to investigate
and advise me Recife ninth.

      FFR wir.e~~hy.is &WC= necessary: answer via Rio
                                           -- ' Patent advisable to
                       __^- . . ~-&  .- ..-. .-
                   payment of roya.-les by u8.I ." -sW---.
                        Pereira Souea representante PAWMERICAN AIWAYS
                            ultimos cases febre amajtella Para nlio satisfaz
inteiramente fim desejado e gede um telegramma seu dire&o a service saude Americano e
esclarecendo situacElo sanitaria Par& de que depende passages avloes ali ponto peqo
resposta sua decisao pan-to Alves.' Replied as follows, "Rockfound ftio. Following
cable sent to Crawford today quote Please in$Jorm  American consul exact known status yel-
low fever in Belem stop PANA?&ERICA% AIRWAYS have received orders to drop Belem from
itinerary because of ruling  United States Public Health Service stop Contrary to my
previous instructions your statement of health conditions Para should be mado to
American Consul and to local Health officials and not to the Panamerlcan company stop
Can consul advise USPHS telegraphically of present conditions. Soper."

AUGUST 8. XI!XOLUTIUN in RIO GRARDR DO SlJL &ported in Wireless messa,@ received on
     board Itapa$.


August 9-.

enroute to
vi-ted both

                                         FLS 1930.
Arrived Recife.  Alarming news regurding u:`r,,, ;-ing in Rio Grando do Sul not
confirmed.  Met by ERR,f Drs. Doyle and Rocha arrive from Parahyba the former
Fortaleza, the latter enroute to SE:0 Paulo, both sailing this evening. In-
to lunch but Rochh had previous engagement.
WRocha leaving our service at the present time because of family complic-

ations in S&o Paulo; he hopes to reenter our service later but I make no promises. His
return massage to Rio is being paid by the service but should he return to work in the
north, return passage must be paid by him. Rocha's work has I believe been satisfactory
although Doyle insists that the service in Parahyba was so good when he ledt it that
it would run itself. During the recent disturbances in Parahyba over the assassination
of Pessza, the service was closed during an entire week; the following weok Doyle ex-
amined personally a large number of houses and found almost no stegomyia breeding. Rocha
is stopping off in Bahia where Davis can show him how to prepare sera for the laboratory;
R has promised to ta3& one hundred venules with him from Rio to Piricicaba, in the inter-
ior of S&o Paul0 and secure  non-immune bloods for control studies in the Bahia lab.
     I wire Davis of this plan and wire Rio to pay Rocha fifteen days salary and
three hundred thirty five mifreis travel.

     Doyle reports that everything is going all right in Parahyba but that he
does not have a lot of confidence in Dr. Porto who has just taken over. Wire Uchoa
that Doyle will be in Fortaleza on the 11th.  Doyle was instructed to take oxr service
as is and make no changes before my next visit to the north beyond increasing the number
of guardas in training; Doyle knows that extensions into the interior are planned for
6he near future.

      ERR reports that INSTRUXENT is PrEat success.
       ERR and I call on Dr. Gouveia de Barros at his home. Sick.
      Call on General Motors regarding car for Bahia.
  Aug. '8. LIVER JOAO JUSTIN0 OF NATAL NEGATIVE LIVERS ADRIAN0 RAMOS SILVA AND THEREZA
       CONCEICAO OF PARA EEGATIVE YELLCW FEVER STOP SERUM TOBIAS PRINTSAK OF NATAL
      FAILED TO PROTECT MONKEY/DAVIS.
      Advised Tavares of Natal results.
  Aug.9. Estive hontem povoado Pindoba situado limite municipios Viqosa and Anadiaponto.
     Then describes in Portuguese illness wit"1 jaundice, anuria and hemorrhages
     which began in May; two fatal cases in July, one in June. Convalescents are
       ictericino recent cases seen. PINDOBA has about 400 housesg service organized.
         Almeida.  (State of Alagoas)/
      This is undoubtedly extension of Vicosa epidemic.
August 10. SUNDAY/ ERR and I go to hospital where he demonstrates the delicate art of
     snagging out liver sections without touching the body or the sections and with
3g;lv the liver punch of his invention.  FFR cable disapproving patent received shortly
afterwards.

August 11.  Following telegrams received:
                     AMERICAN CONSUL ADVISED USPHS telegraphically
today that last confirmed c2se yellow fever was June 21 stop Crawford. (I forwarded
this- to Rio to be transmitted to the Panamerican Airways rperosonta-Live. FLS)
                   DOCTOR VIRGIL10 OLIVEIRA commenced l>rork today
Monday stop URGENTLY NEED MORE TRANSPORTATION FACILITIES stop Wilson. (This is cand-
idate recommended by Dr. Fraga.
made here through Mr. Tate of Gen. To meet need for more transportation purchase was
                 Motors of new Chevrolet touring car delivered in
Bahia at 4:3O#OOC or $462.00 at preseat rate of exchange, Car 1929 model.)

the

     I wired Wilson and Cunningham that FINANCIAL REPORTS of Aracaju should in
future be forwarded to Wilson in Bahia rather than to Rio direct.
     Wired Alves not to discontinue patent process as yet.
     Personal telegram from Doyle's father forwarded to Fortaleza.
     Advised Cunningham of arrival of American foresters in Par&.
     Wired Cmmfngltamega~ding need of more automobile transportation for Par&;
       . ---

at aDove price I feel we should get sufficient dars for the immediate future.

Wa FFR proposing autopsy program on large scale.
    Gouveia who shows telegram from IPIRIlI[BIPBEL@QE~ot-baESTACIO COIhlBRA
          intervention with Dr. Sonper to secure nomination of Dr.
         Yellow Fever Service in Par&.




         ,'

i '
,  /



Aedee Mosquitoes 63' Sgo Salvador, Bahia

May - 1930.

1.    Aedes

2.    Aedes

30    Aede8

4.

6*

6.

7.

8.

9.

Aedes

Aedes

Aedee

Aedee

Aedes

Aedes

Transmit8 Yellow Fever

(Stego~@a) aegypti (Linnaeus)                588

(OohlerOtatU8) scapularis (Rondani)          Yes,

(Obhlerotatua) eerratus (Theobald)

(Finlaya) osnaldi (Gordon & Evans)
(Taeniorhynchus ) taeniorhynahua (Wiedemmn)

(OChlerotatU8) hastatus (Dyar)

(Howardina) fulvithorax (Lutr)

(Oohlerotatus) filvus (Plliedemann)

(Taeniorhynchue) fluviatilis (Lutz)

Yea  Feeding expta. imon-
   clueive.
f      Injection of
   emulsified mosqdPitoe8
ye8 positive.
Yes (In emau $ of 8Xpt8$

No (Adults refused to feed on
    monkey8 )
No ( Negative to date, but
   number8 inPldequate  1

NO  No experiments

Yea.. Readily infeot.

10.   Aedes (Oohlerotatus) crinifer (Theobald) ?          No

  This species ie known to occur  around Rio and further south, but ha8 not been taken
   here.

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

N. C. D.


FLS   1930.

August 12th.  JTA wires that Dr. Ferreira Pinto wishes to work with the yf
         service beginning           September. As FP has been
with the Malaria Service of the Division in the State of R&o for a good many
years, I shall do everything possible to take him on ; probably good man to aid

in epidemiological investigations. It was
from Mag6 last year.

he who assisted me in-collecting bloods

August 13th.  Left Recife at 8:30 A%_ with
          one week tour of the States
following itinerary;

ERR in Ehevrolet touring car for a
of Alagoas and Pernambuco with the

            1st day, Cabo, Excada, Frexeiras, Ribeiriio, Gamelleira,
Joaquim Nabuco, Palmares, Ribeirgo.

Pedras, Barra Santo 2n;o;;sz ;g:;Tira, CucaG,Barreiros, Sgo Jos6, Marogogy,
             3rd da ,
    e spent in Ma'cei'o.
               a , Sgo Miguel, Penedo, S&o Miguel.
               ay, Anadia, Tsnque Darca, Nar Vermelho, Pindcba, Vigosa.
          m, Quebrangulo, Palmeira dos Indios, Bom Conselho,Garanhuns.
          '7th day, ,780 Caetano, CaruarG, Bexerros, Gravatk, Victcria,
                   Morenos, Recife.                                           -
The speedometer showed a total kilometragem for the trip of 1422; notes were
taken during the trip of distances from one point to the next but n.re not included
here as they are of little value in planning tine taken; suffice it to say that
each day's trip carried out according to Tbove schedule gave each or us atl~ $hr
work tie v'ml:k~i' for the day c?r' viny; only one half the distanceA Drivers were changed
every thirty kilometers during most of the trip and the roads ::lerc such that sel- :
dcmedid the man driving forget to look at the speedometer in time to make -%o shi&t.  I
However, with the exception of the zone fn the State of Alagoas bettioen Acadia and
Quebrangulo which is really quite a hilly almost mountainous district, the situation
in regard to road improveaents can be considered hopeful. Dgubtless during the peak \

of the dry season, most of the roads traversed will be in very Sood shape.       !
  Palmares service consisting of three guardas&& one guarda chefe, who also acts  'I
as guarda chefe for the services in Sbo Benedict0 and Quipapg, was inspected by Dr.  i
Rickard only minor defects being found.                                            -L
   Ribeiriiio. Slept hero under mosquito nets ; many culex and ple%y of stegs about
in spite of part time municipal service.

August 14th. Met at Batira Santo Antonio by Dr. Almeida who returned to Maceio with
        us. Reports there can be no doubt of the diagno$$s of yf in Pindoba;

August 15th. Assumption Day and a full holiday for everybody except the yf service

        in Maceib. Announced to Dr. Almeida that from now on he will report
directly to ERR and that $11 report2 of al- to go to Recife; call on Dr.
Meneschal, director of the State and Fe&era1 Health Services here and present ERR
as our sectional director. Discuss possibilities and need for auto!lsieq  ERR goes
over organization and local situation with MA; no changes to be made at'oresent .

time

    .    f
   Dr. %choa wires that m has_-              &+
                     0~ r..&hw&L9g,b pf ,22i2.3&~--Qr.?e~~~~~ t p e
    DBW notified prioe of Chevrolet includes bumpers and &ock absorbers.    .I .s----*
    Authorize Machado to purchase furniture for my office Recife.
    PJC requests another car for Par&; Tate of GM authorized to ship from
Recife one 1929 Chevrolet touring car at 4:509$ plus cost of transportation.
    PJC wires monkey with blood from Kislanov showed nothing in two weeks.
    NCD; Liver Marie Andrade Natal Negative.
        Bloods Raymundo Passos, Joaquim Passos,
Andrade of Par& all failed to protect rhesas.      Francisca Passos and Domingos

    DBW sent copy of yf contract in response to urgent request; should catch
Condor plane tomorrow. I cannot imagine why he needs the contract.
     Residence, Edgar Farias, Travessa de Curro 36
            Harold Chandler, Trav. Bonj. Constant 96   Par&.


FLS 1930.

Auvst 16th.  DBW returned to Bahia to-day after two days in Aracajc.
        ERR MA and I visit service in Penedo, the principal port at the

mouth of the Sgo Francisco River. Call on Dr. Jocelyn Fraga,  director of the local
health post who has not been too helpful in the past according to &!A who believes
that JF feels that he hu@t to be on the payroll of the yf service. Find very inad-
equate installation for handling fish. Rode through large areas apparently almost
uninhabited today between SK:0 Miguel and Penedo. Sleep at SBo Miguel with mosquito
nets; plenty of foci right in the hotel.

August 17th. Sunday. Visit ANADIA again my first visit being on May 19th when I
       was here with MA investigating suspect yf; we came to conclusion on
previous visit that the town was free from visible yellow fever and today three
months later were able to learn of no further susp&cious cases. Also visited the
nearby village of Tapera, also under suspicion on our last visit, and learned thet
here also nothing further has happened.

            Stopped at PINDOBA, 16 kiltieters from Vigosa, long enough
to satisfy ourselves that there have been clinical cases of yellow fever here during
the past three months; it is hard to estimate how many cases or even how mcany deaths
there have been here without making a complete study of the place. From incomplete
information it would appear that some five or six adults at least have died; &&P&en
generally don5 count in a case of this kind here. Our rapid history taking included
one family whero some six persons had been ill with no fatalities. We were also told
that 'many people were sick but few died and that almost all the children were illft
Pind6ha is a small place with hardly enough work to keep one man busy. Service has
been organized and will be continued until all immediate danger is over and then will
be kept under observation and occasional inspection.

       Spend night at VICOSA; no recent cases of yf have occurred and the
index is nuw down to three pn  The incomplete studies of HA indicate that there
were approximately            n Vicosa from February to June with about
twenty deaths.                                         ~--cc--..---~--

August 18th. MA returns to Macei. on morning train because of infected leg needing
        rest and medical attention. ERR and I drive to Quebrangulo; much more
of a town that we had expected; for all practical purposes thznd of the railway
branch and a strategic point. Then to Palmeira dos Indios, the Queen of the Sert&
which is also quite a town for an interior point. Control service was maintained ..
here from August 1st to December 31 last year because of suspect cases occurring in)
June 1929.  On to BOM CONSELHO where we find the guarda working in plain clothes; ._I
reports all quiet here.  Sleep in Garanhuns.

Au,pst 19th. Return Garanhuns Recife visiting SBo Caetano and Bezerros services
         enroute. Arrive office 415 PM.

      Bigo wires Mage complete with many refusals; wire for him to report
to Recife, leaving sera with Davis in Bahia enrroute.

      NCD; I%UJOEL SUJTOS  PAR& positive. PJC wires MS had leprosy, malaria
and had been dead 24 hours before autopsy and requests  reaffirmation of dia,gnosis
.rrom NW Yellowing wire sent NCD;"Crawford reports Kanoel Santos had malaria and
leprosy :toAutopsy performed twenty four hours after death stop Would this inform-
ation alter your diagnosis? Soper."

August 20th.  Authorize Rio to continuesending 15 cantos per month to Cearg.
        Application was made on          a patent on an "Extractor
de Fragmentos de Visceras de               of Dr. 3. l'omaz Alves, pub-
lication occurring in the Diario Official Aggust 8th page 15524.
        Took ossession of the.new office and went to work.
    *-.L&./-"                  w
          10 at NCD request that future shipments of monke   should
come in individual compartments; he reports getting %inety seven live monkeys out       u
of one hundred shipped on last shipment. Of course this is the most favorable
season of the year.

        Robinson informed that we can order the ten kilos of tr?yparsamidc
he desires for ma1 de caderas treatments but that shipment will have to be made
to him and duties paid on importation.


Following estimates submitted to FFR for 1930
  Br. Phys.   18  cantos    2160.00
  Wursing     20          2~:oo.oo
   Office      50         6000.00
   Lab                65000.0@
   YF       2500       300000.00

NCD;  Joanna Rodri,gues, Par&, negative.
NCD copy of letber to PJC asking for collection of blood specimens from Par6
for filiariaris studilr r,? Zrly- 38t!i rcc,oived; I believe such matters should be
approved and arran,ged by me rather than handled directly between the laboratory
and the field units. Shall discuss the matter with Davis when next in Bahia.
NCD letter July 26th," Upon my return from Par& I allowed myself to be per-
suaded that ,the Santos case had malaria only. lsQy present opinion is that vellow
fever is present. I still believe that malaria takes a part in the picture. However,
probably most of the pigment is the result of foma%tifixation." This refers to
the Maria LWORA SANTOS case, BELEM PAR&   March 19th 1930.
   CFragas letter of Au,P;Ust 13th trsnslated and - Oorwarded with CY letter to &iC;
WC apparently gave CF to understand that he did not expect to return to Brazil.

August 22.  Adi&se Rio and D!3W and PJC that I shall arrive in Bahia August 28.
       Bi&o sailed from Rio August 21; should arrive RecFfe August 27th.
Biao lxil.1 spend a couple of weeks with ERR in Recife and then will relieve MA
in Alagoas while he comes to Recife for further training in methods. MA has
done very good work in Alagoas considering the amount of assistance he has had
and considering the fact that he is a home twn boy; better cooperation from
the local authorities can probably be secured with an outsider.
  NCD; Carlos Jo& Andrade, Par& protected
      Jovenilha Andrade, probably protected.
      Walter Gaisle, Ilheos, almost certainly protected.
      Manoel Pelletero, Bahia, negative.

       Arranged for NCBank here to order payment to St`andard Oil in Rio of
218t856$.
      .Pr~.--.
                 and  sent to Rio -autopsy-note for Q Saneamento..   \
                            -.--_ ._ -- .-

       DBW explains that he wished copy of contract to see if v
                       sny'protisiion
had been made for lawyer's services
(Dr. Carlos Mattos,           in the carrying out of intimacGes and fines.
            laver for the SSAP in Bahia had tried tocollect for his ser-
vices in connection with collection of fines: ALBB had gone on record however as
opposed to such payment and injlbsted that he must continue to do the work as part
of the work of the regula r  health service.)
       PJC advised that Chevrolet touring car was shipped him this week.

August 23.  Left Recife 8 AM for Parahyba with ERR; many mhlitary in evidence and
       some burned houses seen; many houses still flying black flags of

mourning for the murdered president and some also flying red flag of vengeance!
Reports are that all fighting in the interior has ceased althou& there may be.
some difficulty next week on the day of the THIRTY DAY MASS.                           i
        Met Dr. Rodrigues Perto, who is now in charge in Parahyba; he re- Y !
ports service in good shape in Parahyba but completely disorganized in Cabedello   1
Present Dr. Rickard to Dr. Alvaro Carualho, now President of Parahyba, who ex-     '
plains that he will do everything ;jossible to make the yellow fever service sue- 1 : i
cessful in his state. Also present Dr. ERR to Dr. Guedes Pereira who promises to , Iii
continue his interest and assistance to the work under ERR's immediate direction. 1
GP informed that ERR ~iy.1 return next week for the purpose of going over the      ' i
local organization and making certain modifications to conform to procedure at
other points. (Intimation and fining services not mentioned today although this
is most important change anticipated; atmosphere one of formal presentation of
regrets over loss of President not favorable to definite discussion of details.)
Returned Recife 8 PM feeling day well spent.


FLs 1930.

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

Aug. 25th. Liver Antonio Joaouim Ferreira, FIRST RO- AUTOP@ SaQ LUI 2 negatim NCD.
      POWER OF ATTORNEY made for JTA to receive from treasury 33 cantos due DNSP.
     Advised Dr. Bailey-to sail for Pernambuco rather than kio;scheduled to arrive
in Recife Oct. 22nd on Almanzora.

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

       Demonstration tide1 of LIVER PUNCH sent bv airmail to FFB.
August 26thnay at office. *B
                                                                eave  10 office without &Lnl.erican
        in charge; suggest JTA be BONDED to handle all financial affafts.
      NCD Aug.21: "In my opinion postmortem changes, malaria or leprosy considered
          individually would not account for the               antos; whether
             or not the canbination would do the tri               ostmortem
         changes are rather marked, bllt there was undoubtedly a pre-existing
          injury. There is a little pigment-not lnearly so much as in some of the
             N,Ital cases. Eu'; there is r!uch fat and ,'.:- ' ?'I-; I-," -tls ccl.3. columns in
             in t,he midzones / There may not have boon much actual necro$s-;-l%-is
         rather hard to say now on account of postmortem changes. Bowover, th.ore
         are inflated nuclei, fading,nuclei, etc., some of T,M.ch rqy have been
         present ante-mortem. Under the circumsttices, and considering
          changes of undeterminable degree, perhaps I should have said, Qd ry
        gostive of yellow fever." That is still my opinion. 'fle shall be glad sug-

          to sh%T you a slide later."( Th' 1s refers to case noted this journal 19-8,
             (-T
                 & P .&&%&-Cm! J
August 27th. S                ahia. Dr. an. &!rs. Cross, Mr. and Mrs. Goodman, Mr. and
         Bars. Gillette and Mr. Tate on board.

August 28th. Met.by Dr. Wilson and get to Pen&o about midnight.

         JTA advises SANTIAGO CASE not confirmed.
August 29th. With DBW call on the minister of Health, ALBB.j who

service as so
ation! (Incidentally this full cooperation began aftor CF's trip
which time CF reported to the Governor that ALBB was,:not showing

is quite friendly at pres-
him an instrument for his
been giving full cooper-
to the north last year at
the proper spirit; the      I

Governor at that time promised that no further passive resistance would be encountered here.)
       Discuss looal situation with DBW and authorise opening in Ilheos since NCD          '
                                                                           c
has reported protection in             ticipation of extended programme suggest
that surveys be made                 are close to Bahia and would logically be J

the first point of attack on extension; Alagoinhas, Cachoeira, Nazareth, Santo Arnaro and
Feira de Santa Annna. In connection withnheos, Itabuna is to be surveyed and possibly
worked.

        DEW suggests that as part of the survezr, larval counts be made on 1000 oon-
tainers in each point; on consideration we decide to do larval counts in Ilheos only for
the present but to have such counts made weekly thus foliowing the improvement with work
both frczn the house index and from the mosquito production points of vievr.
       Rumour has it that the Ministry of Health may change hands with the advent
of the new government in November; Dr. Afranio Peixoto, at present Federal Deputy from
this state is the most talked of o-y Dr. Peixoto is well known to our
service and is very syaathetic to the cause.
          Decide on 1:5000 scale for BAHIA MAP.

AugustBOth.
      -  Day spent at the Laboratory at Montserrat.
      Frobisher's monkey still survives its protection test seven days after inoc-
ulation without sign of fever while the controls and other test animals of the 8811~ series
have either died 31' are velp~r sick; NCD believes in value of large doses of immune serum
early in the diseaue.
      Ma& 'study practically complete; MF would like to secure further bloods if
possible for one year after studies on complement fixation.

      MF "has been working on chemistry of fat in monkey liver; Asks if any results
from Wakeman's work are available; desires pure Hexylresorcinol.
       NCD reports that MOUSE STRAIN was not lost but that his animals are still


FLS 1930.

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

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

       NCD believes that the entomological work of the yellow fever service can be
more profqtablg done by-a physician who knows some entanelogy rather than by an entomologist;
obsoure species oan alTsaays be forwarded to specialists for classification;NCD is not then
requesting the return of Shannon to this field.
     NCD and I have long frank discussion of position of laboratory in regard to
rest of yellow fever service; I suggest that we attempt to mantain contact between the
laboratory and the services away from Bahia through me and that the same procedure be used
regarding contact with the New York office. It is true that I shall be travelling a
great deal but with improved airmail service no great delays should occur, especially as
I propose to keep NCD constantly informed by wire of my proposed movements.
        NCD insists that l&oratory is equinoed to handle large amount of work from
the field and rather ohallenpes the controlmrvice to net enouph autopsies and bloods to
g~rm%p;the works; in regard to ep$demiolonitiudies of immunitv distribution, HCZD says
the laboratory could well handle two hundred monkeys per month rather than the one hundred
now received.

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

       NCD cmplains that no information is sent out regarding the work being done
in New York and in Lagos and that there is no effective coordination of program by the
three laboratorie$ as was anticipated last year.                   1-

August 31st. Sunday.

September 1st. ANALYSIS OF "SALUS" scrapings by Inst.' OS. Cruz. Bahia. MO. 268,
           Anions: Chloro,         .
                    sulfurioo, phosphorico, silica.
          Cations: Sodio, Ammonia, Calcio, Magnesia, Ferro, Aluminio.
                 *, 8th Dr. A. Diniz Gonqalves.
  ( And the propaga$z justifies the high cost of these jars because of the silver
used in their manufacture! !!!!!! )              HOUSE
          AM spent with Dr. Qardoso inspeoting~gutter gangs. Five gangs of five men
each are inspected by a guarda chefe. All gutters are na%rally dry at the present time.
As the work is considered vital however and as the men cannot be easily replaced, the work
is going on as usual but at a somewhat slower r::te then previcusly as each gutter is being
flooded by hand to determine whether it wji.1 hold rainwi-:i:' (_` I.$ *. T:c I: :'lt%'-T*? holding
water are punctured with the consent of the p~?ios concerned!; :.&ore gutters cannot be
punctured legal7nachinery is set to work to require the necessary corrections. As the local
au5horities are giving good support on the enforcement of the law, it u;ould appear that
even during the rainy season it might be well to apply the hand flooding test to all @tters
examined so that a uniform.basis of correction might be had.
          Of the five gangs visited,
in the imperfect gutters;          three were found to be punching inadequate holes
              EC insists that this is in spite of repeated instructions to make
the punctures as large as the drain phpes.  The gutter can-opener invented by one of the
  guardas seems to function very well when sharp;
so that one may always be sharp and in service.  I suggest furnishing two to each squad