Juae 27 Daccq Tuesday. Morning starts at the office
with an attempt to clear up many old notes whihh have been
neglected all too long.
      An interruption comes about eleven o'clock with
the visit of Mr. William Blackie, the local representative
of FAO; a man who spent many years of his life in Kong
Kong in government there.  UB comes in to discuss the ways
and means of bringing about the participation of his nat-
ive New Zealand in the CRL . ..B says that in general NZ
has insisted in bearing its part in the international pro-
grams ( he recently learned almost by accident that his
country had recently contributed two sugar mills to Pak-
istan through the C@ombo plan.). . . ..NZ has been*partic-
ular1.y active in the fields of agriculture, education and
medicine..it seems unusual that NZ is not particripating
in the cholera project which is of basic interest to so
many of tne commonwealth countries. JLS points out that
the idea of a SKATO cholera program was mooted at the
SKATO Conference of 1958 at Wellington NZ. There Thailand
rrewly -infected with cholera after a decade bf freedom was
responsible for bringing the matter to the/attention of
the conference. As a result of this action the USA and SKATO
signed the agrewnt of May 2992959 by which the Usa set up
a sum of four hundred thousand dollars to be spent through
the NIH. on this problem.  I give WB the story of the de-
velopment of the program up to the present time and also
give hi@ the details of the dealings with the COEP during
the past months in getting the decks cleared for furttmr
action. I am frank with W.3 regarding the attitulie.of the
USA in its pecent communications to the INCAP type of
organieation aad take out time to give him the story of
INCAP.... In telling him about the present proposal before
the MINISTER I point out that the only country other than
the USA and the GOP considered is the UK which has already
taken action t*ough# the contribution of the ten thousand
L  to associate itself with the Cl&, . ..Under the present
agreement the third country should negotiate with the WP
in agreement with the United States for terms of partici-
pation..My suggestion has been that the USA and the GOP
should join in iviting the UK to participate. In the case
of NZ it would seem rpproirrFUo appropriate for the NZ
authorities to make official inquiry as to the tpossibility
and terms of participation.  UB Proposes to ventilate the
matter informally with his govermt.


  July 1. 1961. Dacca. baturday.   With JLS to talk with
Big. Hyder for the first time since my recent trip to Karachi.
I rcpoot that 1) Brig. Sherif has seen the draft revision given
to the Minister under date of May 10; 2) word has been received
from Washington of some reservations regarding my proposal;
3) a document has been prepared for the ministry of finance
pooposing that the CRL function through Trust Funrls during the
interim until the revision is completed; 4j that the CBL is in-
terested in getti% direct collaboration with the Health Services
in epidemiological~studies to determine where and when cholera
is occurring mgan'ieed intthe immediate future (Hyder indicates
that Telakudar ? will be his contact man for this purpose);
5) that plans have been made for Dr. Gordon wo come out in Sept.
to undertake physiological chemistry and clinical studies;
6) that there is no need yet for the appointment 6f the bio-
chemist since the material for the chemical laboratory has not
arrived; 7) thq,t the equipment for the water lbboratory is being
transferred this weeY end to the CRL laboratory building; 89ehat
I am interested in seeing something of East Pakistqn and of the
conditions under which ehoaraa occurs (Hyder says there is
nothing better than going down to see the most recent suspect
area on an island off the bb coast of NOAKHALI; I agree to be
ready to leave on Tuesday or Wednesday and be gone for four or
five days;  and so we close the most frieddly meeting with H
for some time past.
   Last evening at the home of the Bloods I met the Chief
Controller of the GOEP: Mr. Jafari ?
   JLS atxl I call on Muazzam Hussain who is very much inter-
ested in everything connected with the development of the CRL.
M rather approuves the move to operate ynder the Trust Fund
during the inferim period and predicts that this period will
be a year. I assure him I believe it can be musch less than
that if I have an opportunity to follow it through the various
Government departments to khich it may be referred; that I am
not ready to begin pushing it until I have the full Concurrence
of Washington to all details of my pooposaal MH asks for and I
agree to give him copies of my revision draft and of the
proposal for the use of trust funds.


July 2, Sunday.

At home all day.

3.
July

  Mrs. Haynes, Dr. W. Griffiths, Dr. Dimarohi and Dr. Paltinieri
visited the Cholera Research Laboratory and all oame to dinner. Mrs. Haynes
and Dr. Griffiths are here from the University of California, Berkeley,
working on the Family Planning Programme, under the auspioes of the
Planned Parenthood Organisation with which Balfour and Jaok Gordon were
working in India.  This organisation is a ohild of John D.R. III whioh
has been helped also by the Ford Foundationl  Family Planning was not
heard of in Pakistan under the previous government when the Mull&s had
oontrol but under the present government the Mullahs have been told to keep
out of trouble by not opposing the campaign being set up by government.

   Dr. Shimmel has moved to Dacca to be the local representative of the
effort here; the work will be done under the supervision of a committee which
has sanctioned an administrative officer at Rs.500.00 a month. This already
seems inadequate to Mrs. Haynes and Dr. W. Griffithe.   The budget for the office
is, I believe, Ks.50,000.00 with a possibility of its getting upto Rs.1,00,000.00.

   Dimarchi is making his first visit here since coming to Pakistan as
Area Representative of the WHQ( Dimarchi was here during the war as a Y.0.W.
taken prisoner very early in the war in the North African Campaign; he was back
here some years ago working with WHO on the problem of tuberculosis. Dimarchi
understands all of the difficulties of working with the Government restrictions
on staffing and on spending; agrees that no one can understand the situation
here unless he has experienced it.

   Dimarchi learns that the Government of East Pakistan has permitted the
budget for the microbiological laboratory in which tt.e WHO was to have
participated to lapse: this leaves the WHO with some $.30,000.00 of equipment,
with Dr.  Woolfe of the Netherlands and Dr. Yen of China contracted to come
in the next few months with no provision being made for their reception here.

   It seems that Brig. Hyder, who is not himself a research man, has decided
that having already spent money to fix up the Cholera Research Laboratory, it
would be duplication to have another microbiological laboratory supported by
the Province. Brig. Hyder apparently does not understand that a highly
specialised laboratory like the Cholera Research Laboratory is not prepared
to take over the functions of a general microbiological laboratory and that both
are needed here. While the Cholera Research Laboratory can, and should be wil-
ling to, help, it ismt to be considered as a Teaching Institute nor as a
general laboratory for routine work.

July 4th.

   J. Cassanos arrives says he came from Karachi to Calcutta with J. Killen;
that J. Killen apparently talked with Jes. but had no comment to make! ( So
that gambit failed) ( J. Killen is to leave Pakistan in August; where he will
go no one knows?)

July 5th.

   C-M. not present in the morning; is taking the day off for discussions
on nutrition with Kamaluddin and the Vice-Chancellor of Dacca University.


  Water Laboratory materials from Parsons Co. were delivered on the
30th of Jun and on the 3rd of July. The problem now is to get it unpacked
arrl installed.                                L.

July S...Dacca.... tnroutc to the office JLS advises me that
Cm is not coming to the office this morning but is goin with
Kamaluddin Ahmed to see the Vice-Chancellor of the University
of Dacca (really the Chnacellor since u$f
the Gmernor is the Gha,,,lor~r~~to~~~~~~~i~~~~
the stafffhouse before leaving  or the University; Cm pointed
out that the visit was with regard to the-Nutrition Program
being sponsored by the NIH and had nothing to do with the
delivery of the #$24 000 NIH grant for the study of anti-
biotics and medicinals which the University is getting for
work to be done by KA. I expressed surprise that,Cm had agreed
to 80 with KA to discuss this program with the Vice Chancel-
lor and indicated that I thought that KA should not be allow-
ed to free - wheel with NIH interests at the Provincial le+el.
. . . . . . . . ..In the afternoon Cm repobted ii that he had had a
talk with J Cassanos with ragat@ fi the developments in Kar-
achi in the negotiation of the Nutrition Agreement; that
apparently Ted Owens has been busy with other natters and
has not acted in this matter (over looking entirely that
this is not an ICA project; thgt nothing -actually
happening and that everything is at the mo&&&:an-Xdead center.
. . ..Cm reports that JC is returning to Karachi. in a few days,
that Brigadier Sherif will be back in Karachi Monday, and that
he Cm proposes to go to Karachi to see what can be done. When
I insist on knowing specifically what he expects to dall in
Karachi, Cm says that he expects to talk with the disbursing
officer about the possibility of making payments directly to
`Dacca University for their part of the program instead of
routeing all of the money through the National Government
(that is the disbursing officer of the Embassy, which will
be the channel through which funds will emerge)...that he
expefts to discuss the situation with Sherif and Inquire
as. to the acceptability of certain changes in wording in the
agreement... and that he expects to talk with others who
may have experience in writing agreements with the Government
of Pakistan...... After all this, Cm will write in to the NIH
making recommended changes in the agreement now being drafted
in Washington, so as to avoid some of the pitfalls Cm has
begun to recognize here.
forkgoing to           I indicate that I see no reason
       Karachi at this time; that he must be careful
not to become the cat$ paw in a struggle between the nation-
al and the provincial authorities; that he has no basis for
suggesting alterations with CSherif unless he has written
approval of these alterations from Arnod Schaeffer; that
Sherif is not able to agree to any alterations without con-
sulting the Economic Board which I understand has finally
after consulting with Ted Owens given its approvdal........
(CM has forgotten that ehe  Vice-Chancellor is the one who
should take up the mateer of direct receipt of funds with
the National authorities and not an administrative officdr


DIICC~... July 5 pure 2 of the NIH. Cm also seems to forget

that in the hierarchy of the Orient he is not in a position
to negotiate as person to person with the Vice-Chancellor
and with the Director of Health Services, even though he may
have a letter fromArnold Schaeffer asking and, authorizing
him to look after details here for the Nutrition Program.
I suggest that Cm should act by reporting to the NIH and
should make no moue here until instructed specifically to
do SO..*.*- I further suggest that he might find it useful
to suggest to Dr. Schaeffer that he see Joe Smadel, read _
the CKL agreermtnt and my voluminous correspondence on it
since March 14th, in Smadel's files.jI indicate to cm that
if it takes my authorization for him to move to Karachi at
this time that he will not gob*...

In the evening, JC comes

to dinner with the`stockards and the three of us have an
opportunity to discuss.the Nutrition Program and Cm& re-
lationship to it. JC says that Cm had talked with him in
the afternoan and that he had indicated to him what the
present sta,te of affairs is in Karachi, that Ted Owens has
been busy with pressing matters for Killen and had not been
abie to give Pavcek immediately his analysis of the Nutrition
Agreeamnt but had not suggested that there was anything to
be gained by going to Karachi at this time. JC was surprised
that Cm had been to see the Vice-Chancellor; and said that
he was sure that no one in Ica would want to see him talk-
ing things over informally with Brigadier Sherif.

   In the above account I failed to list among the things
Cm proposed to do in Karachi was to talk thing s over vith
Maljor Siddique, the national authority who signed the agree-
aunt qith Schaeffer, and the head of the entire program.
A reaspn for going to talk things over with Siddique is that
S has no one in East Pakistan representing him, in spite of
the fact that as thirlgs are now bging planned most of the
work on this program &b&k& during the firat two years
will be in the east wing... I suggest that there are postal
services.. and that in any case it is not the function o
                   to act as messenger boy&ax


July 6...ccrtain correspondence from Washington regarding
other xmtters and an indiaation that correspondence is taking
six days to reach the DC but 40 indication that my letpers
siace the secind 05 June have been eceived....
Talk with Dr. Dimarchi regarding boats about which he seems
to know a lot,. (D returns on the 7th and reports that there
are United Nations advisors here telling the Gov't of Pakistan
what to do about boats for best usage in different parts of
the country. D has made arrangements for one of these UN mem
to call on us . ..In looking at the map with D, It appears
that we may have been a little hasty in saying no to the
8 ft draft quarantine boat.....

  D reports that he has made arraxgdments to have the
biological (public Health )laboratory here activated and that
he is proposing that the CRL have an intimate realtionship
with it. I assure him that we will do everything possible
to collaborate byt that he must rememeber that neither
JLS nor I are essentially laboratory men.

July 7th..get authorieation to have 150 rupee cash advance
for minor expenditures... Sayyed Ahmed is responsible for
this . ..he asked for 200 but got cut back to the smaller
amount until such time.as a year's experience may indicate
that the need is for a greater sum.

. ..authorize the attempt

to get the offices on the top floor fixed up for operations.
It is believed that the administrative offices should leave
the second floor space for laboratories which may desire
access to the patients to be on the ground floor.

I t should be noted here, that as usual, there were certain
misunderstandings, or at least varying positions taken when
a lengthy discussion occurred regarding the  Nutrition af-
fairs. It now seems that Cm did not see the Vice Chancellor
as he had expected but did talk at length to Kamaluddin, who
war able in spite of my admonition to Cm to be on his guard
to convince Cm that it was Cm's place to propose that funds
shoilid come directly from the American Embassy to the Univer-
sity for the work in KA's laboratory and Cm was so far con-
vinced that he wanted to talk with the disbursing officer of
the Embassy regarding this possibility...JLS and I both in-
sist with Cm that he should under no circumstances becomg the
ca&'s paw in the contentions between the national and the
provincial authorities . ..That Cm is not in-a position to
discuss any changes in the signed agteement with the GOP
ntil such time has he has definite instructions from the NIH.
. . . ..CM has begun to realize some of the difficulties which
are just around the corner for the nutrition project and
would like to prevent some of them if possible,,I repeat the
suggestion that Arnold Schaeffer should go to Joseph Sma
read the CRL agreement and then look over my letters to w ,

an autonomous agency operating under a committee of inter-
ested individuals from the Ministry of Health, the Ministry
of Agriculture, the Ministry of Education, etc.............


July 12 1961 Dacca to Karachi. Enroutt tothe airport
JLS gives me Better of July 6 from JES..This indicates
that there may be some possibility of getting a independent
status established for the CRL....Talk with Mr. Mayhew, a
construction man from Chittagong on the PIA 101 flight.0
M assures me that an interested organization can get imned-
iate delivery and shipment of goods and equipment from
Chittagong.... he has been doing it for the plst four' years.
. ..ICA transport leaves me abandoned at the airport for some
time..find Caleb just ready to go home as1 arrive at JC's flat.
+J
July  lk with Ted Owens indicates that he hopes to get action
from Ministry of Finance on the modification of the CRL agree-
ment tomorrow...conversation later with Mr. Dhamee indicates
that this optimism may not be justified sincnhough the
Ministry of Health has given its approval in wrtting, nothing
has been heard from the Provincial authorities in Dacca. (D
says that he is all for the program as I have outlined it,
now that he understands what it is that the NIH has in mind..
that is to say my mind.) I promise D that I shall stimulate
a reaction from Dacca. (This I do later on July 15 by calling
on Additional Chief Secretary Haque and askinghim to check
on communications from the Central Government relating to
the amendment and to the kBevision.1

  Consult Iffy Rogers about the possibllipp of ICA taking
over the receipt and transportation of UK materiels at Chitta
gong for our account as part of ICA support..IEogers says this
can be done...

  JC and I have a session with James Killen who says he
backed my position with JES, insisting that there must be
something IpOre than had been indidated by Cummings Grant and
Mills..JK admit;&$that JES admitted that some o-f FLS measures
were not entirely those which might have been expected of a
properly respectful subordinate. JK advises if possible to
go to the Minister next with a final document ready for GOV'T
approval..

Visit the Director of Health 5erviees, Brigadier Sherif.
At one point Sherif asks me if I feel thateventually the
work of the GRL might expand to the point where a special
building might have to be constructed to house its activities.
I assure hilj that the probabilities are that, once a base for
research has been established, expansion  will occur, and
the goverment being willing such expansion would obviously
not be limited to what can be carried out in the present
quarters. I also indicate tlqt we cannot afford to be in-
different to the Hans for the construction of a teaching
hospital (communicable disease& on grounds close to the
Institute of Health. The CEL and the NIH would be interested
in seeing such construction being adapted to the needs aloe
of medical research.

Haque and ask his attention to the matter of getting an
answer back to the Central Government on the queries from
GOP on amendment and revision o,f the CRL agreement.


Xeek of July 16 to 23. Dacca..

iio effective diaq-kept durir&thc)~ree%
week. Items renemembered;
x.Cassanos--repsrted on Satwdny th@t
Ted Oxns had finally zone to the !

t-

course Dhaxee had not seen the ?a-
3ei-p but TxomiFed to do sol. of--
.L- -.-e -- -L. ~-2z3..-.- --- .- -
course Ihmee had to choose the  I--

next day to be ill, etc...but the
- -~-
pa3ers io.~%.j n& ljXl<~ at- the TEji~r
of Finance and may dell be cigled
m. i . .~-. .~ - .--
b. Addti&nal Chief Secretary Zxp?
tells me.of &3e.!&g.resmt in one of
the candidates who is to i-iork -cTith
the CA%; also reports thnt he has
-sent the proj?osccl revision back td 4
@rachi zith a no~x of appoval.

f~arently 4&e -TYttS% Fwfzt ~3qers i
never c3ine to t; e Provincial 1eve-i.)
,c,lj~._fu~.r-+~~ cp+m~~~$~.~*uio~~ -from. j
JES of proposed SE4TO aCreement;I
finally :,rrite pointing out that at'
2 Xfri6~~vk~n Eie nek3pZipers~ 5r% -re-i
;3orting President Ayub's adverse /
eommts OR SUTQ--to -Preside& -2%;
it may not be highly propitious to/
-gush the tic up:;itkl SEPITO. But  /
even more Sundame:Aall;r, there are/
good reasons for not getting the I
technical CZX-too-closev t%ed in f
xith the actual mechanism of any I,
~lat%e& 03?g`aYh&ion.- ~-P;ttmtien [ ~--
is called to the'fact that INCAP '
i3 really a legal entityand that 1
there is nothing to prevent the   :
USA the UK and the GOP from making;
the CRL ~equally indti~endent and
able to operate uned its o:m steam.


ii `6 /
Ju y 26. Dacca..
i!         As-planned I go with KAMansur to visit the laboratory for
the manufacture of cholera.vaccine.This laboratory under the direction of
Ataur i Rahman is supposed to be geared to the production of 8 cruores (80
million) doses of vaccine annually.  Recently it has been decided that the
vaccine produced should bed a four-fold vaccine with T A B and cholera!
AR has protested that he is not equipped for such increased production and
KA M hasbeen asked to look over the installation and come up with recommend#fbd
ations.  (AR says that his present production of TAB is about 50 000 doses
monthly as a maximum, but varies in accord with.the demand. The TAE vaccine
is produced for sale whageas the distribut,ion of cholera vaccine is free.)
The visit starts quite naturally at the bottle washing service, where flasks,
sealed ampules, and ex-beverage bottles of all kinds are washed. The ampules
are made locally from glass tub'ing imported from INDIA; the local packing is
not too good with the result that about 2% of ampules are broken before washing
begins. Broken ampules are discarded.... Beverage bottles are purchased from
contraatbors for 8 or 9 annas each and then have to be thoroughly cleaned, in-
side as well as out....th9  are of course irregular in size and shape and
color.... Their use as culture bottles meqns they hlive to be rolled by hand
to get a wide surface for bacterial growth; RAM insists also'that the amount
of agar needed for these bottles for a given amount of surface is much greater
than is the case with the wide flat,bottles made for the purpos which also
have the advantage in stowage. The round bottles are rolled by hand on cakes
of ice for cooling.The collection of autoclaves in use, and in disuse is very
striking; Maay in use are electriczil;&me which were electrical are now being
heated with kerosene burners.  Othe dry heat sterilizers are being heated with
burners in a room which is too hot . ..really too hot for humans to work more
than a few minutes at a time. (Since the containers are known not to be afr
tight sterilizatoon which should take one hour is being continued for two,
three and in some cases four hours.) There are now 26 sterilizers or autoclaves
in operaton, fired electrically or by kerosene burners. Considering this ape+
ation and the cost of electrical current, together with the needs of other
parts of the INSITUTE it is difficult to jastify the absence of a boiler room
and the distrlbhdion of hot water throughout the Institute. Inoculation of the
culture material occurs in three rooms . ..During the Monsoon sea-on of high
heat and humidity  about twenty percent of the cultures are discarded because
of contaminatmon . . ..The filli`ng of ampules occurs in a M&f&i&vacuum tank and
seems adequate... The attempt to label the ampules is primitive and the packaging
is woeful; 5 % breakage in transportation to the field. (It is obvious that
East Pakistan cannot afford to continue with :the manufacture of vaccine under
the prdeent con%itions; nor is there any resonable way in which to get the
4-fold vaccine under production here without making arrangements for reorgan-
ization of the laboratory and the installation of cnsiderable amount of import-
ed equipment.)


Dr. Berwyn 1. Rattiron MD.
Kxecutive Director-
APW   New t3Eod~  4& Y. *

Dacea -Boat Pakistciir
ufuly 18 1 1961.

Dear or. betixent.
         Saw. days ago I received your note raquertiqg re-

co-endatione. .fao. ugo9ait.ton ofmrkurc ia the health.-f$ald -fw uee
by Dr. Loom hurgartner, who in apparent.ly on a cmJttrL frnr a ICV
award to be graeLid by the APM.                   s         
      ' 'Yithout @owing to0 luch about thb' podlt&am j

the ward I em tbming up w$th `thb n@i of two -Fititer&. ol[ r;Li &I-
States who havd- diode out8tandlm$ wqrk with the `.&tier.pa&uel. klil',
organirat#oar. I uy~organfrxtionr"baciliie I a& unddr the mtidti !
that rias her beek OR tha bay&l of the P+SB add && otbar 91 at-.bd
the WHO.                                 .                       *          .,   
         The first m.$ I would propose ir that of Neria i

Scrimshaw, M.D.; +h.D.  giP.N. pho joihd the etaff pf the Pau Ameri-
can Sanitarf BtirCau in.1949 ad the C&i+ Conryltitit Xn Nut*ici*od, Just
at th time that the PASB wai beginnie to fuxktion abe aI' the UBO
M~ional Orgaaixation for the hart&ax. ,. pr. Scrilrhaw was asrigned
imediately to the position of Director of the Institute of Nutrition
of Centra 1 American, 8nd Pa"bs*k .'  XNCAP had been dreamed up in 1946
with a roawwhat limited proSram in blochtrsistry in which the Kellogg
Ioundation and the countries of CA and Panama were to collaborate in
#@@&a the bfo-analyris of heal foodrtuffr under the administrative
guidance of the PASB. When I learned of thit project after becoming
Director of the PASB in 1947, it se-d much more important to me to
develop INCAP on as wide a scale as possible, rather than to use the
limited resources of the PASB in attempting collaboration with the
countries of the Amrfcar in programs on the basis of then existing
knowledge.  Scriarhaw proved to be a tremendour combination of tech-
nical training, inspiring leaderrhip, and sale8manrhip; the record I
feeld jU8tifie8 the deCf8iOn to concentrate very largely the effort8
- of the PASb during a full decade in the INC@ development.  It i8
to be noted that Scrirokaw developed the progrol almost entire*
with pereonnel fr6m the umber states) aho it rhould be o epha8i8ed
that although Incap ha8 become known all over the world for its
H:ientific work in tropical nutrition, it bar served over the year8
as the coordingatiag and stimulating center for nutritional work
  in the 8i~ MPPbar8tate8 . ..It seems appropriate 8t thi8 the, when
Dr. Scrirrhaw has finally acceded to the prersurer of MIT, to give
me recomioa to the out8tanding work he and the PASB have Qae
in helping seix countries to develop a pgram which none of them
dould have atteapted alone. (1 believe it is sound to reoognise from
time to twe outstanding work done by international cfvil servants
at level8 below that of DireCtOr8-ChMrPl.)

            The racond nsme I would suggert ix that of
Ruth Puffer, who had an outrtqnding career in rtatirticr in the US
before join&q up with the Pan American Sanitary Bureau about ten
year8 880. (I frank)y do not know whether Ruth'8 8alary 18 paid by
the PASB or by the UHO; Ruth ha8 rerved the interotr of both organ-
izations with hearty zeal wherever and whenever there was an oppor-
tunity to promote the production of rtatistical activities.) Dr.
Puffer ha8 during the decade done more to develop the collection of


worthuhile  stati:  cs on mortality and morbidity   :uughout the
Americas than I haa ever imagined could be done. An outstanding
development has been the creation of the International Statistics
Service (I have forgstten the exact title ) in Venezuela which is
now financed by the Venezuelan Qqrnment.  (Over)

As en additional rcsponsibl1ty Dr. Puffer has been active in the
preparation of vital statistical material for the P+SB, for the WHO,
for Congressional Casmittees and for Iaterrrational b;onferances such-
as that o# the I Orgmisation of harfcan States -!W~&;held in July
or Augu,p& Wri.1.  Ruth.hao beea aklel .-to .get more Utegast. in and
more fmds for, Ebb &velopment of statistical uorjti. id\ the health
field than any one else. The importance of. book kebpiw lklr health
services is of essentially the qme lmportanceafor bbnks! I
believe. t,his is a suitah&&-,occa$3on kd' reGsg&e tI&;:*tstanding
work chid Dr. PuJ'fer! has -done' i`n the. intefnatio nal f&&d. I iould
suggest,`that more d&&ire3 infdkm&tiqa &Xd be h&ily $upplied
by Dr. Hykon UeSmsa, who `during'. his f&es i&h thb &B-j& thoroughly
familiar tiith Dr. Pufker'*s aktivltles;
Pleodk adv%si bona that. bar 1etLer' re$iiiking imfoklp;piod' or
sugSesti&i on' Braril red+hd& me by slob- ma1 1. iri'th' Fh; r'eqlk ibk
she hi %a' `Bh"irI befiird' `1 %nww kh2e +j' 8otng.
                            i 4              I..L
              SincereXy yoarrr+;
          `Fred L.' &per, M.Y.
                                  ~ /              .


July 31:

Received suggestion that the Cholera Research Laboratory

should be a SEATO projectwith& SEATi, writing a research agreement

with the NIH.  'At his request I discuss this matter with
%Ir. Archer Blod;I agree to write out a note   for discussion.

     Telephone call from J. Cassanos in Karachi who says that

he will wait to hear from me before taking any

on the SEATO recommendation.

   J. Cassanos saysfiy d ocument regarding the use of Trust

Funds is in his hands; a copy will be sent to us this week.

     Visit of Brig. Hyder and Cal. b;allick and 4 of the adminis-

tration chic #s of the Health Services,
  f                    as well as doctors Ataur Kahman

and Sayyed Ahmed for discussion of Cholera studies.  I indicated that

we are interested in knowing where Cholera is when it is there, and

also where cholera is when none is being reported.   As the first

step in this  epidemiological observaticn it is proposed to have
in the hands of each health officer, some bottlesof culture medium

Once the

which can be very simply inoculated with a rectal swab. o OOO=***Q

inoculation has been made the bottle is to be placed in a mailing

tube and sent by post to the Cholera Research Laboratory for diagnosis;

Cholera or Not Cholera.  ( Since the culture media is selective, no

other diagnosis will be attempted. >

B-H. seems very much interested in the opportunity to get

diagnosis of suspect outbreaks ( Not cases) and asks us to meet with
                                  \

the large group of Health Officers called for the 18th of September.


After visiting the various parts of the laboratory we go

to 640, Dhanmondai for fruit-juice and cake.

August 1st:                 ON 7wE

Yesterday JLS and I called J&&-W&e Consul General, Hr. O'Donnell,

       CUE returns from the LISA.


       Talk with %\P.J!  once more and given him more definitely my

reaction to the SLATU proposal.  I JH.LT.5   with the impression that

he is more favourably inclined than H I          to go along with


it.  I draw a diagram for him which I am unable finish'becasue there is

no logical way to bring 3 countries  to %%'under  an ag reement here

with one of them making a separate agreement with SEATt! regarding

the entire operation!

August 2nd:

Talk with CWE regarding SEAT6 proposal. CL:'E thinks as had I

q&ohs 15 p/or
  . . . . . . . . . . . . a workable agreement and that probably I should have a

face to face encounter with those who have made the proposal.

Telephone call from J. cassanos regarding 'Trust Funds which

cannot be iw&p& according to Curtis, the controller, without the
                     kJNb4

preparation of a budget of some a&&en.  ( I/ask for the instructions

in writing as to what is wanted.)

     I tell J. Cassanos of CM suggestion and get from him Si % cl's

opinion that the D Council I would set up would be a very legal body.

Indeed.


FLS DIARY 1;GTES

August liJ, 1961
   GACCA.

    Spent most of the morning with the Deputy Secretary

of tiealth, Mr. Zaman, completing a working document covering

the revised draft Agreement of Xay 10, 1961 for discussion by

the Provincial Authorities concerned viz. the Additional Chief

Secretary and representatives of tiealth and Finance.      1

    At the Deputy Secretary's suggestion, I write to the
Additional Chief Secretary suggesting 'an early meeting of tne

interested parties and offer to attend in order to clarify any

points which may seem obscure.

     Discussed with the Financial Liaison Officer, Plr. hloazzam

Husain,a resource of Public Law for HdO (104-K) Funds.  The basis

of our discussion was a copy of " C.l. AGKICULTUXAL TKADE. C&VtiL-

tiI'k&NT AND A%ISTA:JZE ACT OF 1954, AS ANEKDELl dated Sept. 21, 1'359"
from the Consulate and a copy in his possession of the Agreement

between the Government of Pakistan and the United States of America

authorising the utilization of certain funds including 104-K as

the United States might decide.  A thorough study of these documents

seemed to convince I\ih that the subject did not require further

consideration by us!! '.


AAl,ilst lC, '61.

  DACCh ( E . F . )

bpent the morning at the Lden building.

Deputy Secretary of health Zaman and I completed the

draft of a working paper for discussion by Frovincial Authorities of the

Revision of the Agreement of Gctober 14, 1960 rroi?osed by 9LS on A:ay 10,

1960. ( This working paper is in general in line with my opinions although

I had to give in 2 or 3 points.  tine of these was of course trte matter of

ownership of equipment after` the a;' reement ends and the other was with

regard to the administration and operation of the hospital which I fully

realize must be in the hands of the Cholera liesearch Labcratory.)   Laman
               plea               td
writes a very strong $&#I&  f or making it Fossible /'attract Doctors in

Government employmelit into service with the Cholera kesearch Laboratory.

I write a  note rd Z's suggestion to the Additional Chief becre-
                       /

tary (i-iaque) telling him we have worked together on the draft l'ayer and

offering to be&&able for discussion of the revision and the ,ciorking

paper any time he may desire.

Discuss question of iL 480 funds 104 K with $4. liussain and

we finally agree that LL, 480 Y. Eunr!s really do i:elor:g to the uSA to do

with as the USA may desire.


       tu 15
Au,ust 14/, 1961.

FLS L;IA.kY hiiTES

I! A C C A.

August 14, '61.

      hational Holiday, Independence Day.

      Spent the day largely on the "Eradication of tuberculosis"


paper.

August 15, '610

         In the R.il. attend an opening meeting of the Conference

on Communications f-ledia.  The present government is taking many useful

measures in developing means of communication with the population,

especially the rural population.

         c.i;. advises by telephone from Karachi that he did not leave

on the plane which came down in Jaipur as we had thought; that he did
see Arnold Sc'h&ffer on Pionday and is remaining in the West until Thursday

in an attempt to get the nutrition agreerzeilt signed.

      cleeting in the evening at the home of the ichimmels: l*:oore and

T~iomas of the Ford Foundation.  Aslso Dr. i<ab who coilfirrris r,xy impression

of the x-ray I saw last week.

     In the afternoon I received the official copy of my letter to
the Additional Chief Secretary of August 10, proposing a meeting for the
discussion of the Froposed revision of the agreement of C!ctober lci, 1960,
and a call for such a rzseting in the Office of the Additional Chief Secretary

tomorrow morning at 0830.


August li;, lY61.

Li A c c k .

Aug. 16 :

F,eeting at o&30 in the vffice of Additional Chief secretary,

K.A. liaque, the others present being the Additional Chief Secretary,

brig. Fi.2. ifyder , ?ir. S.A. Khan, the Secretary of the Finance Department.

During the discussion of the 5 page document the Deputy

Secretary of iiealth and I pre;;ared together last week, I pointed out

that a full line has been omitted from t,le first paragraph of PA;

the line omitted was the 5th line from the bottom? of the paragrai;h

which proposed the exclusion of the employees of the ChL from the

application of the Government Kegulatioiis relating to a;:proval by

a conunittee for rates of pay for ;,ersons secunded to foreign organizations.

I also called attention to the fact that sub-paragraph 5 contains

a statement which is true but is not mentioned in tne revision as stated.

In the discussion of the revision Hyder says that there will be

no occasion for hiring field staff for the CiiL since hehas more people
         *hat

than he knows&to do with.  I am ilot convi~lced that his people will be
                                 ( nor
able to get al?. of the s:,ecimens we want m/ P"k"l"c,d.
                                                             . . . . . .  t!lose s,Jecimens

adopte-; to trte needs of the epidemiological section.

arig. Hyder and the Additional Chief Secretary coxverse at

length over a short document which 8.C. had apparently prepared Lifter

which the KC~ s.b+K$ of ir,.;)ossibility of giving control of a hospital

to soneone other than the health :,ervices.   Tile r-C2 ;las tile idea chat we

need a committee to ci;ritrol operaLion of the :;os:jital but ;,aman, whu lb &S

joined the group sncrtly after the discussiotis start gets L!; t<J say tnat

wlk3.t he really wants is a voice in ti.e 0;yeratio-n of the ilospital himself.


i 2 j

Colitd. from hu:;ust 16, 1961 FLS Diary hotes.

      2 and I agree to work up a draft on t.iis ;point and we get an

agreement from the group on the other points discussed, namely, ownershi:> of

equipment and the payment of bonuses to employees of the C2.i.

      In ti-ie disucussion of the hospital administration it becomes

ai:parent that i and I came out of the meeting with difierent understandings.

So we returned to BIi's office and found indeed that there is a'misunder-

standing!  liowever, it seems to be all cleared up when I learnt that the

real cause of bh's interest in this problem is in being able to use the

hospital for a certain amount of training of his own ;jersonnel.   1 nointed
                                                                          L

out that if he gives us the best he has, we can do something for them in

::eriods of a year or loilger, but that with poor personnel, we have no

opportunity to help him&&r help ourselves.  de agree aa6 the chcice

of personnel to be seconded to the CKL hospital will be selected by

H! and the director of the Laboratory.

Au&ust 16, Cond:

        I finish the draft of the firovincial bovernment position at

the CKL in the afternoon.


ku,ust 17, 1961.


        -, -, /
  D A L L `3 .

Early  to the office of L- fir .  Laman, the Le;ruty Secretary

Of iiC!Zi!tLi tL bresent the result of my efforts yesterday in drawin; UC

a position ,>aper fcr the Government of Gast Pakistan on the proposed

revision (dated  i%ay lljth) of the Agreement of October 14, 1360.

      I find Laman pushing really hard to force us to pay for the

further costs of adaptations of tne building for the hospital and for

the laboratory.  Zaman calls on his financial man and snows papers

indicating that there has already been sPent some 2b0 thousand CC.. against

a commitment to spend 220 t,,;  ianan says that he does not know whether to

get the r:loney for the new changes asked for which illc s;ys will amount to

soxe 3 tti 4 hundred thousand ;c-;.

      I pointed out that,dnl compensation for tile additional er:;)en-

ses on buildin:. the
         "/   government has not made tfie i3cjOC monthly available

to the Director and that the balance of the 15i~ticI KS., for last year (fiscal)

must be very large.

      I pointed out tnat nctnink was dolie about the hospital between

December 1'960 anti k-arch 1361; that I was seriously promised ti; build r ad
                  ;*lg,
for tile hos;?ital during the third week of k*arch but that only very recently

nas the work on tile electrificz,tion been more or less cor:qleted.

      L and I try tc, find a way to justify tnis expense from 1.5. funds

including the present use of government funds duriiig t;;e interim .eriod

but fail t,r: find a loop-hole. < I itisist LO ti;e end I c;nnot laj; down the

bars and spend li:S i;oildrcss aizpropriated        fur building construction./


                   i 2 j


COiit inued f TOii, hu,;lst 17,  161 FLY jj-j"`ay ;;,<;`r;ib

      1Je finally make minor changes in my document, cha;.;es whicti
in no way alter t'he ,in&&I had in writing the revision and the

draft position paper.


          L says he will get irrxediate action on this paper and that

it should start  to ICarachi on t:ie 1Ytki.


i:u~ust 17,

                                                                 L `>
                                                 11 cc

      News item in yesterday i'al er reports cholera in barawak

sci;le days a;;o t!.e voice of :il.:ericc reL,crted cholera in Ciiina.

lrbl.


A

      ri ;,csccw news iter.1 in the Dacca ;:aper : i.cscow, j.u,,ust 12th.

II 'The is.*i: conquest of r;,alaria, sr,lalIpcx, dracunculosis anti other

Earasitic diseases will be the subject of an International health

Conference in TasAkent next rborlth.

     Public representatives frolc India, the UK, the Sudan, Kenya,

Ztliiopia, Af&hanistan, Japan, Chile, Cuba,  brazil and !:enezuela have said

they want to attend,"

       Another interesting news iter.; refers to the 1'i 46G agreement

with Pakistan wl,ich has been altered a&ain to include 125WU tens tif
wheat, ($7,7GU,GOG), Vegetable ii1 ($315citiUG) with trtinspcrtaticn costs

of $1,75OWG. " As usual about 80% of the sale proceeds of t:.e commodities


             . .
ln I'aklstan KS. will be given in the forri of loans or grants in project

assistance." ( 'I'he report does Ilot say SC but the r,L 4BOr$
  Noa 11:4 1; funds cor;ie froro tiie other 2L;% which is retaiiied for

ex,:errditure by tlie LS C;overnment. j

         This afternoon we receive a cr;eque for ? .3Gi,ciL sii;ned b,, i:lice

Jackson; tilis should kee;. us going for a short rericd of ti::;e considering

the fact that we have become accustomed to not spending money.


August 19tti, 1361.

Li A C I: A.

Saturday :

Sarly to the bank to deyL;sit checiue for !:-.30,0W/- from

ICti for staff and operatis exi enses during tile i:;terim .eriod.

Ifr . CJayyed khmed tells me that he still t.,il2<s he silculd

be given an offer of a pcsltion bz the ML. I tell him we have not

made any decision regarding technical staff dnd will have to do so

in concurrence with ttle iiirectcr of Iiealth Services.

'I'alk with 5.A. and learn titatz he was at one time responsible

for t?le anti-mcsc,uito surveys (Servicesj in Dacca. `ibe found it i!r:;:ossi5le

to check the work of the men in t1,eir areas; finally   hit   on tne idea

of  judging   their wcric entirely 01-1 the basis of field checks of mcsquito~~
           than              all
breeding rather/b y direct checking rS#? the workers while at wcrk!

       Says he is not in&COP&  with the present anti-mallpox

car;,paign whicn claims to have eradication as its aim.  SA would make

it necessary for everyone to have a certificate of vaccination inmder

to receive pay, purchase, transportation or any official action whatever.
~1s~ he would pay #g! vaccinators according to the number'of persons

vaccinated with checks being made in the field as to the number vacci-

nated,


IW
August 20 Dacca Sunday...Day at duty on tbc paper; on
letter on syphilis er&.ication to L. Eaumgartner r<io;:; Terry
has ca& chief of task force to tell how to eli.min?'te this
disease as a public health problem! !I!
      Jim Cassanos calls to bring ne5:s regarding the
legal status of the EL accordinS to the Revision pro,nosed
on Nay 10th. SieC;el has decided that the opinion given me
by gassanos by telephone and quoted by me in letter to JES
of Aug 3 was not his. (This ppinion had been requested by
the-cable of some weeks ago asking us to proceed to negot-
iate;I had asked Siegel for an opinion andhc had t&nded to
side with my opinion but not fil*in enough for quotation.)
At least JC's quoting &egel and S&?@$ quoting Cassanos
did finally smoke out an opinion.)...Siegel did suggest
that CF& might be authorized under national law as an ele-
mosenary institution, or by presidential decree; or and
this xould be better from our     .
                      s.t91*~d;30iil~t  the FWision of
three months aso might be redrafted-rrith'a definite declar-
ation of the status of the CF& and establishing &hd list-
ing its juridical powers as a legal person. Siegel would
prefer to see the CPL established under Pakistan law but
FLS insists on maintainen maintenance of international
status. (FLS r:rould not object to a lax authorizing the
international organization to operate Tithin the country
except that this xould establish a precedent which x,:ight
hamper activities here or in ot:ier co, ntrics later.


rc* S-8
REY. r--+.56,                                                   AlJTHORlZATlON NUMBER
RMUiST AND AUTHORIZATION OF OFFICIAL TRAVEL              Ml22     --
                                                                     DATE
ERNATIONAL COOPERATION ADMINISTRATION                 Augtmta2,lea

1.  NAME AND ADDRESS OF TRAVELER            1 2. STATUS OF TRAVELER

                               0 ADMINISTRATIVE EMPLOYEE
m.lredL.sopu                    @ OTHER (Specity)       NIB Faploya
                                         .__-_____                -.
kjational Snmtltuto of Emalth, m 3e OFF'C'ALSTAT'oN   Daooa, Paldrf8n.

!                                                  -

4, This &cument becomer en o uthorization of official travel only when the certificate of authorization has been signed by the dsrigoeted a&&zing
officer. This travel is ordered on official business for the convenience of the government. V~U&WS should be rubmitted promptly es provided in
the eppkeble reguletlonr.

-.-

5. APPlKABlE hilZGU@~I~NS: Travel md -
               rwessary upensos ace authmized in acawdmntll with the f7 ?CA Manual Or&r 560.1, 0 Standardized

Government Travel Reguletiom, end the maximum per diem under these regularions is allowable unless otherwise noted in item 6.

                                                                           -
6.  ITINERARY, PURPOSE AND SPECIAL AUTHORIZATION

ommenaingonor abouthgwt 24,1@6l.
                                      ,

7. A?F'U.OWlATlON LIMITATION SYMEOL  ~2-ar-m   ALLOTMENT ACCOUNT SYMBOL  I  REQUESTING OFF= swun

la-50-391~oy69-xl      Poraomml Offioalr Qt
@l. # 1634 &,/      DATE:    IsopaA!am

"

9. CERlTFlCAlf OF AUWOR

--I CERTIFY thet this authorizmtion ha berm epprowd as indicated iq item 6

                       Ams8tmt PLrootw-~
(wqfe of Authorizing Officer)                                  0

IMPORTANT-Every J6 out h er and Message Concerning This Travel Muot Refer to Autho&ion Number and Date st Top.

COFY FOR TRAVLLLR - SEC REVERSE SIDE


  ET,
t , REV. (9.56)*                     1 AUTHORIZf@N NUMBER

/ i REQUEST AND AUTHORIZATION OF OFFICIAL TRAVEL
     ?NATIONAL COOPERATION ADMINISTRATION

2. STATUS OF TRAVELER
  0 ADMINISTRATIVE EMPLOYEE
m OTHER (Specify)
3. OFFICIAL STATION

                     n*  ;, c &  I ..t.t:+i -8..

4. This document becomes an authorization of official travel only when the certificate of authorization has been signed by the designated authorizing
officer. This travel is ordered on official business for the convenience of the government. Vouchers should be submitted promptly as provided in
  the applicable regulations.

5. APPLICABLE REGULATIONS: Travel and necessary expenses are authorized in accordance with the c] ICA Manual Order 560.2, 0 Standardized
Government Travel Regulations, and the maximum per diem under these regulations is allowable unless otherwise noted in item 6.

6.  ITINERARY, PURPOSE AND SPECIAL AUTHORIZATION

0.

    tt pg 5 t'  : & .r;:Ltd
    (Signature of Approving Officer)
,/-g ji ci.*.J.$.b; ;. &*j,`iE. :. B`ii*
            (Title)

* I;   ; CC%& * _ .*-, .
  Other Required Approval

9. CERTIFICATE OF AUTHORIZATION--I CERTIFY that this authorization has been approved as indicated in item 6

TYPE

  OF

CURRENCY

      FOREIGN CURRENCY ESTIMATE                                 U. S. DOLLAR ESTIMATE

USE FOR AMENDMENT ONLY        ESTIMATED      OBJECT        USE FOR AMENDMENT ONLY         ESTIMATED

INCREASE        DECREASE      COST (NET)       CLASS        INCREASE        DECREASE       COST (NET)
                                      020
                                     PER DIEM
                  ANDO:YAVEL
                                      030
                                   TRANSPORTA-
                                     TION OF
                                     THINGS
                                      TOTAL
            I II--h     I I     I I

IMPORTANT-Every Voucher and Message +nxrning This Travel Must Refer to Authorization Number and Date at Top.
                          ra.*


Dr. Joe L. Stockard, M.D.
jholera Eesearuh Iaboratory
Dacca Rast Pakistan.

Dear Joe:

Iola Kamzs
Saturday sept 2 1961

   J'
   /I           ?        /
'AT%- ' Y./w
     :,   .-' /
4    /' c          /

0                            J

     Just a line to keep yea up to date with happenings outside of
Kast Pakistan . . ..The stop in Calcutta was uneventful excrept for the last
tiute discovery that1 hadfailed to have M%ss Middleton enter my recent
vaaoinations, especially the vaccination against cholera on my yellow oer-
tificate, although I had made speoial t&p to her baillwlak to get Juliet's
vascinatlon properly reaorded... I ehall give youlaterthe denouement~!l
      The C&plans travelled onthe same planewithus to Hong Kong

as did also Mrs. Wong and the five chlldren....the Caplans spent two days
in HK and took the sam plane to Tokyio... In Hong Kong airport at tims of
departure we found Dr. and ?@a. Warren Weaver, previous to retirement a year
or m ago a vice President, of the Rockefeller Foundation...and on the plane
fro# Hong Kong to Honolulu, a Rr. MCCulloch of the USRB and ICA whom we had
flrstmetln Eangkoksoiaas year8 ago.... So you see we felt accompanied most
of tile way....

      In Hong Eong we were not met as the Consulate had reqoestid,
beoause, itappsare,mynanswas givenonthe cable as Dr. FredSoperMing!
However, the Hotel Mlramar runner piaked us up and later in the evening I
got in touch dth Dr. Colfer of the USPIE on duty in Hong Knog who gave the
gtid tidings that the next day, August 30, would be a holiday tith Gov't
offices closed . . . . ..So there was nothing to do but get out and look and shop
until ones money and feet gave out simultaneously....

      At the Medical Service I found Dr. David Maokensie, to be the
;~i) Dr. Mackensi.e I had first raat in Africa 8onm years ago..we were later
together at one of the World Health Assemblies. He appreciated getting the
note and the news from the Blackies, Dr. Mackenzie, Dr. Franklin, Dr. Alwree
and others were most helpful and I came awaywith six cultures,two fromthe
begin ing of the outbreak, two some fifty diagnoses later and two of the
most recent. I inoculated two of the Mansur sultures from cultures and two
with mot01 swabs of the most recently diagnosed oases.
      When I was in HK there had been 11 deaths in 98 casesrtoday's
Kansas City Star reports 12 deaths in 104 cases There was a deolaration In
the Knog Kong paper from Canton inslstlng that t&em had been no cholera in
djmmunist China but that there was an outbreak of para-aheibra dus to elTor
vibrio, The outbreak inHkis all due to the same organismwhloh seemstobe
a mild OGAWA strain of vibrio. MPokennie is inclined to believe that the out-
brak in China 5s an extension northward of the otitbreak in northern Tailand
Ins January (Decwmber) wlah prevented the appearance of Felsenfeld in Daaca.
I believe these was belief that that outbreak mpy have been due to the ElTor
org&mism. In any case adreat deal of interest ia attached to the propem
IdentiUicatlon of the H ng Kong organism.
      The flight-from Tokyio was via Wake, as I understand occurs
quite regularly when PanAmerlasn Is able to arell a hrge number & seats and
thus has reduoed oapaoity for fuel. Thus we arrived In LA tea hours la$&
and found ths airfield fogged In although the rest of the ama appeared
clear. We landed at Ontario flf'ty mile8 east of IA and drove in by bus
getting to bed at 0400, with reservPtions onward set for C945:i
       Kansas has been 0001 during August and evergthing IS still
,reen and the cattle all look fat and well fed in amparison with others
we have seen recently; none of the oorn has been fired and mine a It is
yellow, between KC and Iola nor between Iola and Wichita.
      Enough~ Juliet joins ms in sending our best to yo$ and Ann.

Sincerely yours

Fred L Sooer.


(26 April 1965, mnc)
Original dated October 1901

                                  2 r.,`i
                       .f\ 1 -L,"t ' /"
PAKISTAN-SEATO CHOLERA RESEARCH LABORATORY
      Dacca, East Pakistan

  Astuunded to receive two cables same day (October 52th) regard-
ing CRL participation in cholera epidemic in the Pacific3 the one
suggesting the Deputy Director of CRL be offered to the infected
country and asking CRL opinion of sending additional diagnosticians
from the USA, the other advising that NAplRU is moving in on the tith
inst., that NIH is moving in with Feeley of NIH and Smith of Jefferson
for three weeks bacteriologic research, and that, if feasible, the
CRL should participate by sending Stockard for three weeks epidemio-
logic support to Feeley and Smith.

  On receipt of the first cable, it was thought the CRL might
send Stockard to take Hansur to aid in organising field diagnoses
with very limited equipment and at the same time establish CRL on
the map in such a way that another nation might be interested in
participation in CRL.  This would also add to KAYs prestige and
that of CRL here and might even influence his continuing in cholera
research.

  After checking to see if JLS could leave for a few days arxzI
discussing with Mansur the possibility of his release from commitment
to attend the CENT0 meeting in Karachi next week, I was prepared to
cable suggesting JLS and KAM proceed to the infected area, but that
diagnosticians not be sent from the USA.

  The second cable indicated clearly that nothing could be gained
for CRL relationships with the country concerned and that KAM had
nothing to offer since Feeley and Smith are fully cognizant of the
details of his medium.

  The proposal that Stockard should abandon the CRL for three
weeks to give epidemiologic support to the bacteriologists shows a
complete lack of understanding of the conditions surrounding the
very existence of the CRL, or should we say the Facts of Life of the
CRL.  CRL is beginning to grow, slowly itis true, but it cannot
simply be abandoned for three or four kzeeks at the moment of making
changes in the buiiding, of training the administrative staff, and
of getting Government cooperation.  Also, the CRL is just now rea@
to develop some epidemiologic work in East Pakistan based not on
chasing epidemics in other countries, nor on chasing in to study
reported outbreaks here, but rather on getting systematic routine
collection of cultured material from outbreaks of diarrheal disease
to determine when and where transmission of infection occurs through-
out the year.  The CRL is interested in studying the life history of


2

FL3 Notes on Pakistan-SEATO CRL (October 1961)

cholera rather than the l+fe history of epidmics of cholera.
(The Rockefeller Fourxiation in 3razil began to learn the facts
regarding yellow feverandtobe able to eliminate A.aegypti-
transmitted yellow fever only uhen it ceased chasing and control-
ling visible outbreaks and introduced systematic routine viscero-
tumy to show where yellow fever was when it was there. Let WI
notwastefifUmnyears, as the Rockefeller Foundation did with
yellow fever, and chase cholera in Hongkong, &mila, Sarawak, or
wherever it mq be until we have something to offer.  Stu* in
depth the endemic centers.  Pmbably cholera can be best studied
W
  a. Routine school stools when diarrhoea is present,

   b.  Concentrated sturdy of limited area in known endemic
sane of East Pakistan.  Launch trailer census, etc.


(28 April 1965, -1

Plate at entrance, Decmber 5, 1960.

Bacteriological Laboratory working at that time.

1.  Bacteriology, for epidemiology of non-epidemic cholera

Water Laboratory3  Help solw question of seedbeds of
infection in Delta areas about the Bay of Bengal.

2.  Agreement

a. Eio longer bilateral-technical aid pattern but working
   unit devoted to solution of problem.

b.  Mechanism for multi.lateral participation--DC never
   planned for 2 country programs, UK and PR represen-
    tatives here.

c. Nechanism for international assistance--to countries
    tith cholera and to those threatened with cholera.

d.  Autonomous agency can receive grants and operate freely
   so long as it has confidence of those with the purse
   strings.

3.  h%iderllic of 1961% Macau, Hongkong, Indonesia, Communist
   China, and PF?. very useful.

Thailand invasion, 1958-59, stimulated creation Cholera
Research Pmgram.

Mestern Pacific invasion 1901 may well serve to consoli-
date position.

Yellow Fever in Cear& in 1923 opened Brazil to fiF work.

Invasion of Rio in 1928 resulted in development of
Mational Service with linkage internationally with
Yellow Fever in all other countries in South America.

Interesting to contrast with Pellow Fever Eradication and
Malaria Eradication the two preceding international attempts
at Communicable Disease eradication.

Yellow Fever! Began with full knouledge and complete confi-
dance. Learmd later that YF was not a aim&e ebidemiolosical.
problem.  Settling for eradication of Aedes aegypt in the


2

Anmticas. (Maqyyears before YellowFever Servicehad
its own laboratory.)

Halariat Began alsowith cotiderable knowledge aad demon-
stration of eradicability of malaria. Cholera is beginning
with conf'ideme in eradicability, but tith confession that
we do not know axact3g what technique can Ix used most
advantageow3ly,

Rsnewed interest of WHO.

4. 1962 ticsit of four mm&em of the h?IH Cholera Advisory Corn-
    dttee and two consultants.

"It is vital for the continued development of the CRL that
a senior scientist or public health expert with broad expe-
rience in a~nistration azxi in international. affairs be
recruited promptly to serve as a Director of the Cholera
Research Laboratory.w

Qqetience during the past twelve months with cholera in
mainland China, Indonesia, Sarawak, Hongkong, and the
Philipptiea emphasfaes the need," etc.


(28 April 1965, mnc)
Original dated 1962

FLS Note8 on

CHOLERA RESJURCH KABORATORY

Since arch (1961)

Recommendations and Requests

a.

b.


C*

d.



es.

f.


g.

INCAP-Type Agreement
(FLS in the middle)

Bacteriologist

Water Biologist

AgainstApri1Arriva.l of &tzner

Information on 3 Horsemen

Against firm orders given by RIH on MC's recommendations.

Not consulted on date of Uordon's arrival, nor on arrange-

menta for Macflityre and 3 clinicaJ. men next year.

   h.  Against shipping of Trailer and other supplies at the time.

   i.  Dollar expendi tw unknown.  (Rupees expenditures brought
under control except for 35,000 dollars worth of FL 480, but nothing
on dollars.)

   j*  Ho Adgiscuy Committee.

   k.  HacLeod, Goodner, Wodward, and Smadel. (Too much Ameri-
cans at this time!! Retzner came when not wanted and left when
most needed.)

   1.  &&zner instructed to write back to JES,

  m. Gordon sent out with instructions as to what he was to do
until he took over as Director1

  n. Gordonhadinstructions to reportweeklyto JES. Maintained
HacIntyre a8 his man.

o. Announced RO as Mrectoq 10 dollar bet. I would not come back.

   P*  Countermand order for tape recorders.


   90  Arranged trip In September, &ads1 ami Mills to negotiate In
week or else!  Cables sent to Pakistan on trip.


2

FLS Notes on CRL, 1962

  r. FLS against Nepidemic'g chasing3 against Stockard to PI for
three weeks.  CRL should have brought in NAMHH--Feeley and Smith if
needed.

  s. Beeley and or Smith should be in Dacca; CHL must be "source"
of cholera NIH opsrations3 not a peripheral "saurceR of things to be
studied.

    t.  Must accept CRL as rapid development to get what CHL has and
what it is, where it is!  (Gorgas' first trip to Brazil, 19163 FU?
began YF worm<@&, or seven years later, and only in 1930,
after another 7 years, was full freedom of action gotten. INCAP
organisational meeting at Tegucigalpa in February 19463 INCAP's first
small laboratory inaugurated September 1949, i.e., 3-l/2 years later
with only three countries.  Present building with six countries
participating was inaugurated September 1954, another five years later.

  u. Prioritieat Bacteriology, dpidemiology, Serology, Water
Biology rather than Physiological Chemistry. (Treatment is important
but early and careful treatment is doubly important.
In most arsas
early treatment will not be available.)

  v. Instructed to teach JLS administration to be ready to take
over.

  Uordon invaded office and gave letters directly to secretsxy3
KAMts paper, took over sponsorship without consulting anyone3 although
he had nothing to do with stimulating work to be reported.  (FL.8 knew
of no funds with which KAM could be sent to USA3 JES immediately approved
HG*s action and KAWa trip to Atlantic City.

  JES approved Mrs. Schuler as secretary at 4500 dollars per annum!!
Without consulting as to whether we wanted her or not. Cable authoris-
ing was of course widely known in American offices.  I was embarrassed
no end.

GOEP. Director had no function3 dollars controlled by JES3 Rupees by
   Trust funds only in late August. FIS' resignation really in
June3 confirmed in August.


(28 April 196c', mm>
Original 1962c- '. !,I

CHOLERA RESEARCH XABOFUTCXE

Ii0 has shown no interest in a&ninistrative matters
has failed to follow suggestions
  haa free uhealed
is a free wheeling dilettante

Proposal for study is obviously not fundamental to solution of
cholera problem

   "DR. GORDON will head the Clinical Research Section and will
be in charge of organizing a new ward. He will investigate the
possible role of nutritional deficiency in susceptibility to
cholera and will also collect data on whether recovery from clinical
cholera produces lasting immunity.

(below)

I offered to set program along his lines of thought, asked for
plans ami progrm
  staff

Full week-nothing--unpacked  cases --read papers at Medical Society.
I learned of their progress at midnight, before reading.

No advantage has been taken of our overlapping periods of service.

Rsp0~ng directly to you--not to me.

Attention was called early in 1961 to need for bacteriologist;
later I called attention to need for water biologist.

2 men here--never asked for.

Gordon considers MacIntyre his man.
Corclon said he would not work under JLS3 JIS is not anxious to
have administrative responsibility under Gordon.

Heed for senior director.

Leave JLS as Acting.

   "DR. MCINTYRE will assist in the clinical and research work.
He will conduct a number of studies including an investigation of
the role of nutritional deficiency and anemia in susceptibility
to cho%era."


2

FL5 Notes on CFtL,1962?

Director Designate is as ready as I am to take over the laboratory
of clinical meatarch.

1.  Reaction has been palpable in Bangkok, in Dacca, in Karachi.

2. Demand of "in consultation with Government of Pakistan."

3.  Free wheeUng from beginning
   Refused to accept identity of CRL
    No indication that he ever left his own section in NIH
   I insisted on communicationa thrwqh Mrector's Office;
    has notccmplied.

a. Insisted ongoingwith JLS

b.  Told Zaman yes , we could get money for building and
  construction costs.

c. Nansurpaper

d.  Has indicated hia continual interest in research and
  desire not to be involved in administration.

  The CRL cannot operate as an addendum to NIH under care of
Adndnistrative Officer.  Hust have mature Public Health Service
officer whose primary interest Is administration.

  The CRL, with thier agreement, becomes an institute with unlimited
possibilities with all phams of cholera!!! EJIH cannot leave to
uninterested and unexperienced person.

  Note of imubordination to be put on the record of a. I do not
care how brilliant RC3 may be.  I will not work -4th anyone who flouts
all suggestiona laade by me.  I shall talk with RG and report further
to him regarding the situation; but when I leave someone in g place
as I did with Dr. Stockailrd, I treat what is done with him a~ having
beendonewithme.


NATIONAL

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

IEALTH

BETHESDA `4, MD.

AuguYt 15, 1961

Dr. Fred L. Soper
Director
Pakistan-SEATO Cholera Research Laboratory
Institute of Public Health Building
Mohakhali, Dacca-5
East Pakistan

Dear Fred:

Needless to say, I was sorry to get your letter of
August 8 which firmly states your intention of with-
drawing from the Cholera Research Laboratory at the
end of your year of residency in Dacca or when the
new agreement regarding the reorganization and
financing of the Laboratory has been signed. For
myself and all of us connected with the venture,
let me express appreciation for your great help in
getting things underway.

While I accept the finality of your decision, I hope
it will be possible for you to arrange the timing of
your move from Dacca so that it will interfere as
little as possible with the smooth, continuous build-
up of the Laboratory.

I shall write you in a few days about ideas, suggestions
and plans for restaffing the Laboratory.   I want some
time to think clearly on the matter and to obtain advice
from a number of interested persons.

With very best wishes.-

Sincerely yours,

Dr. Shannon

       Jo
Chairm n,

Q ph E. Smadel, M.D.
   H Cholera Advisory Committee

                    cc:              Dr. Gordon
                   Dr. Watt    Members, NIH Cholera Advisory
               Dr. Cummings    Committee

National Cancer Institute    National Heart Institute   National Imtitute of Allergy and Infcctiour Diievea   National Inatitute of Arthritic and Metabolic Dkua
National Institute of Dental Research    National Inltitute of Mental Health   National Institute of Neurological D&set and Blindnuc    The CllnicaI Center
Division of Biologics Standards         Divirion of General Medical Sciences        Diviaian of Research Grants         Diviaiou of Research Smicn


MENORAMDUM
_c -s-.-w

TO:

Members, HIH Cholera Adviasry Cumitt;~e
  DK 0 Burrows
  DP, Chewer
  Dr, Gooelner
Capt * Kingston
  Dr, PlacLeod
  Dt, Mast
  Dr, Pease
  Dr. Woodward

FROM:    Chairman, BXEI Cholera Advisory Committee

SrnSECT :  Dr, Soper's retirement from Dacca

    X know that you too ~541 be sorry to learn from the erx?oset
correspondence of Fred's deciston to return to Washlngtm la&
next whiter,  Zn&ed, if he fs able 20 accmpllsh tk.e ~~eor~snb;.x~icfi
and f&lzancing of the L&oratory be%ore that tize, he vishes tu be
relbeved of his respensibblfti.es in Pakistan this ?all,

Enclo3urss

cc: Dr, Caaarm3qa
  Capt<> Phillips
   Mr, &mm
  Dr, Soper


COFH

Dacca, East Pakisax?.
August 8, `r96l

Dr. Joseph E. Smadel
Chairman, Cholera Advisory Committee
Natiozxal Ipistitufes of Health
Bethesda S MarylaxI

Dem.7 Joe:

    Some we&s ago 1 wrote you statFwg that a fm%ly
decision. bad been takena rest to con.tinue living in Daeca
beyond February ox Mar&h 1962 and suggesting ?he possibility
of an earl&z teminatioas of my assochticn with the Cholera
Research Laboxatory.

    I have atempted to make an objective ana1y~i.s of
the situation here and belj.eve it Is for li7tte begt interests
of the CRL and the WT,H effort cha^c. a director be appointed
as soon as possible after the E@vised d.greeaen,t i3 sIgned
to operate under Ft.

    In the meazat Lme I) news has come of dlhess $2 the
famlky which rm.y make  F t extremely dif%hcux~t for GS CO be
outside of the IMted States.

    This is the ffrrst real letter of resigm.t~oc I `ha--;~
ever wcii33xa; my leaving the I?oundatim ti~as an i;Tc 3 0 iat Igzp-2:
to serve with the FADB. H find ir difficult to :3&n aff
this projeet which with a Ikttle tiu~a and patiern~ mxsfng
has great potentialities.  --_--. __--- - -  .  .

./- ---~ -      \
                    Sbacerely you3x,


August 15, 1961

D-K. Fred L. Soper
Director

Pakistan-SEATO Cholera Research Laboratory
Institute of Public Bealth Building
Hohakhali g Dacca-5
East Pakistan

Deer Fred:

Needless to say, `B was sorry to get your letter of
August 8 which firrmrly states your intention of witin-
drawing from the Cholera Research kboratory at the
end of your year of residency in Dacca or when the
new agreement regardfag the reorgmization and
financing of the Laboratory has been signed. For
myself and all of us connected wsith the venture,
let me express appreciation for your great help in
getting things underway.

%hi.le 1 accept the finality of your decision, I hope
it will be possible for you to arrange the isi~ing of
your move from Dacca so that it wLll interfere as
little as possible with the s~~ooth, continuous build-
up of the Laboratory.

P shall write you in a few days about ideas, suggesti~s
and plans for restaffing the Laboratory.   I waFat scme

time
from


With

to think clearly ow the matter aad to obt.oin rdvice
a number of interested persons.

very best wishes.-

SimerePy yours I


Dr. ha!tLn n. cnm~r, #m
Dr. Clifford A. Fcasc, ICA

l-k, sup&s letter af July 23

   A tbcmmfax copy ef W. Sup~-r's lettcr to me dated July 29
fr ea8clrrted fat puur iafcvrmst f.ms.

cc:  Dr. Sopar


National Insizitutes of Health
Bethesda 14, Maryland
August 11, 1961

TO:

Members, NIB Cholera AdvLeory Committee
DP, Burrows
Dx. Cheever
Dr, Goodner
Capt, Kingston
DE?, BlacLeod
Co10 MarPon
Dr, Pease
Dr, Woodward

FROM :    Chabrman, NIB cholera Advisory ComFttee

!xJBJEoT:  Intesh report

     Frustration continues in the effort to m&e available for
cholera research in Dacca the $400,000 worth of Pakistan rupees
which the NIX has for the support of the cholera weak %3 East
Pakistan,  Despite the difficulties, I expect to resolve the
matter before Hovaber when some of the vlsitzing scieritPfic g~oi;ps
may wish to begin collaborative studies at the Cholera Rencajrch
Labotatof-y Fn Ewcca,

    Plans are proceeding smoothly for Dr, Robert S, Go~rdon end
Dr, 0. Ross McX.ntyre to arrive at the CR& ln early Bctobe-s,
Dr, Gordon will serve as Chfef of the Clinical Besear& Section,
arid Dr. McIntyre will assist him,  The plans enconpa~a the
establhahment of a phyafology laboratory and the activation of
the X-bed cholera ward which is located on the first flGo;: cf tb-e
CAL wing of the X:nstl.tute sf Public Health,  MLlch vi?.1 renu:lc1 50
be done in accomplishing these after their arrtval ir, Dacca,


    Y
.._



   Within a few days, 3; hope that it: wfll be poss$ble to
offer you lldeas and proposals regarding the work and persvnzzcl
of several visiting sctentific groups who are cons%dereng
stud&es at the CRL this fall.  At the moment, the subjects
which have elicited the greatest dnterest are those comer-ned
wfth bacteriological and Qamunologlcal aspects of cholera.
One of these has to do wbth serological surveys includi;ng the
applLcatLon of new dLargnostfc procedures,  Another would probe
the posslb%l&ty that a booster phenomenon obtained with a
single dose 5f cholera vacctne in a population fn au endemec
area might play a signfficant role in rafsfng "the resistance
of such persma during an epidemic. Other ideas nlad plans
wilt undoubtedly come along bn the near future:.  L shall keep
you informed.

   Xestcrday I sext you a cable through the State Eepartment
asking that you xaturn %n early September to amist in rsaegoti-
cting the C8.L agremeat hex-e.  We shall have an opportmity to
diseutw the mattegs nrentimad above at greater length while
you are in Waahtngton,

Very best wishes-

Sincerely your8,

cc: ?3r. Shannon
   Dr. Watt
  Xk, Cwm8nga
  DE, Stockard
  Dp+ Cordon
  Dr. McIntyre
  NIlI CholeYfa .Adv 0 Corsmll
  Capti Bh&llips