2 1
:  I/          &2iALt>&&W hf *
  `Nov. 14, ,"Ii,i bd     ipp-J.J JJyf * ihA-IQb/~
    Karachi>from t&istrict of Col&bia via New ork,
                 f   November 24,1960.
     Thanksgiving dinner with Turkey at the home of Ruth Puffer and her mother.
   Sam giddleton of Chile and Mrs. Chavespf Brazil with her five children

       were also there. Dr. and Mrs. Villa$eal of Mexico,with two of their six
    children,came in later in the afternoon.

To

L% $he National Airport at 16.50 in order to catch EAL -grC 864 to Ne$&rk
at 17.20; arrive in Ne v ork on schedule and am surprised by the new Eastern
Airport Building but astonished by a circular round house of the Pan

American Airways.        jfp. 3 ar
Pan American A+r"yays_Boeing 707, fi 20.00 o'clock via London, Franfurt,
              4 &L*?`.-+ )
Vienuga, Istambu2,.W
h/N. >G            and Karachi at 0230 on N&vember 26th.
                              M Y,'57-
   Karachi, met by Dr. ETil  Pal & .uiB and 4. Paql A,Nicoll,who has been
here for just over five years in connection with the teaching of basic

sciences in preparation for the sr edical school#$. I suspect(ZG@tt~~7]*
is with the University of Indiana although he did not  def m  say so.
Mr. James Cassanos,                                                C' G
            who used to be in East Pakistan, was at, B acca Airport.

I am taken to the Sind Club where I find a very pleas nt  two-room suite

with hot and cold runing water and a very obsequious 4, earer who anno&nces
         0330

himself at 03+9 and asks what time I urged tea. I could not have cared
less but tell him to bring it at OF00 thinking: I might be ready to rise

at that hour.
  E?il Pal

     TG-
whom I tried to.,- some years ago and who lat#er

served time in Iran and possibly elsewhere but had to leave ICA for family

reasons, has been sent out to Pakistan to size up the health ,situation and

come up with recommendations for a program as an arbiter between the USOM
chief (Killen) and Pease and EPC.

  Killen, who has lots of intelligence and common sense,told ICA some
weeks ago that he wanted nothing to do with the health office; that Pakistan
did not need health work,but dams and bridgyand roads and other productive
efforts. EP has been sent out to survey needs and propose some kind of
                                .   AlaI
concert of effort between K@len 811       $
                   the off'ice,Public Health of ICA.

   It is possible that JK took the action he did in order to get some
greater interest of OPH/ICA in this country.

P.T.O.


-2-

Nicoll has a daughter DBbble, real name is k nn,and a wife who paints and
drqws. Debbie is now a senior or 12th grade student.

November 26th. Tea at nine, lunch at one4and then to the Nicoll's

with Joe Smadel who  arriv edthis afternoon and E Palm&St and Mr.  Cassanos

tc dinner on wild duck.
See a small soft bellGr, (And 1,had cur&d duck for lunch at the Sind Club.)
         aLat the home of the Nicoll&.
   Sunday, November 2'j'th, morning discussion of various matters witch
                           -1
Joe Smadel.                              '9
     (Among other things I ask Joe's about John Doe>learn that,.JD
came out to the NIB to c$rect a situatibn but at the end of a year this
                                          c

situation had not been corrected. (2) J#J was;taken[thenl down to the surgeon
general's Office but after a time it was thought best forihim to go tz an
*

&t-of-Washington post to ride hi%d some of the PHS interests there. '(3) J$

believes that JF may never cause enemies to be made but that he will not
be powerful in solving difficulties.
   Sunday ev~NA~vb~-~
                    27thfdiscuss with Joe Smadel the question
      --

of future funds for cholera work and x3 for the research program. He indicates
tnat the bite can be put on the Heart Institute for the salary of Gordon

if Gordon,;be induced to come to Dacca and that in the final analysis meney
can be gotten through the recommendation of the old original committee
on grants of the parent NIH which still functions in the case of new fields
and was recently used by J.S. (that is a year or so ago) ingeting funds for<

Journal notes.

November 24 Washington.


I,
November 283 Karachi      /'

The international field and the constant neces:;ities of USIA and other

US propaganda in being ayainst communism instead of being for something,

there comes an interesting discussion of what our objectives should be. K.

says that he had an opportunity last year to talk serio:lsly with Awere

Harriman and tried to impress on him the neces::ity of changing the US

approach to international aid.  As a matter of fact the preamble of the

Mutual Security Act was altered this year a?d K. suspects that this change

may represent AH's intervention with certain members of Congress.   Not to

be outdone in citing the names of important persons I related a story of the

initial development of the IlAA and my part in the early discussions with

Nelson Rockefeller in ,!4&:i:?42.  I pointed out that all too many of our
       P

people think that we want to build mmethinq we can point to with pride as

a USA contribution whereas our single objective should be to  z&e it por;sible

for the people of each country to carry on for itself.  (K. then gives the

story of what happened here in the solution of the housing problem of the

refugees!  When the Government got really interested the U:;Oh! financed the

construction of a large number of quarters which have been recently

inaugurated.  The USIA and other sections had been anxious to take pictllres

and make active propaganda of this work ofthe US but K, insisted on leaving

all of the credit for the Government.  As a result on the day of the final

inauguration the President gave full credit to the USA for its part in the

program.) Towards the end of the eveni. K asks that I make myself avail-
                             -.---    --I ----I_- ---Fe

able for consultation on problems not related to cholera and 1,of course,

cannot ref!.se to do anything in my power.  I did not, at this time, call

attention to the complications which may result except to point ou_t that


I am rmr& now under an appointment, until r.ext July, as consultant to ICA.

(I learnt from JES that he had assured K. earlier in the day that I might

be very useful to him because of my previous experience in international

health work.  K. had told JES, it seems, that he had never had, in the

field of health, representatives of ICA who co-Id meet the doctors of

Pakistan on a man to man basis, Kingsland, Donovan, etc., and that it is

hopeless to try to work up useful heath programs under these conditions.

It seems that K. recently indicated in definite terms that he expected to

close out all public health work for the USOM here; the result of this

attitude has been the demand from headquarters for a survey which is now

being carried out by Emil' Palmquist.
         f         So I may soon find myself in the


muddle!  Not too happy a prospect.)

   One of the interesting things l.earnt on this visit is that a recent

meeting of the Pakistan Medical Association was set up as an international

meeting with great emphasis being placed on the participation oftie USA.

It seems that the Pakistanis had invited the Red Chinese and the Russians

and then felt that they might be misunderstood, if there were no American

representative.  Advantage was finally taken of the presence of Ochener in

this part of the world to have an American present.  0. presented a paper

on lung cancer but the representatives of the Communist countries made much

of the story of what they had done in the control, nay, eradication,of such

diseases as smallpox, malaria, cholera, etc., the diseases which continue

to be serious problems in this country.  Obviously the USA was out-manoeuvred

at this meeting.

November 29.  Tuesday.

   To the ICA with JES to see Mr. Owens and Ilr. Siegel.  (0. is a bright


-3-

young man who has been through a period at Rureau of the Budget and S. is

the lawyer of USOAl.)  For the first time we get in contact with the working

element of the US Government who know about the agreements with the GOP and

about the handling of funds.  0. tells us that the procedure established 15


for a fiscal officer of N.I.R. to make a request to the Treas!lry department

for the purchase of ?? number of rupees; the Secretary of

then asks the financial officer here in Pakistan to make ?? rrpees avail-

able to NIH.  The fiscal officer eventually gets word at the NIH that the

money is available and makes arrangements for auti;orised persons to draw

on these available funds.  (Funds for cholera can be dispersed (1) through

the American Conculate representative or throug?l ICA Finance Officer in

Dacca (2) through the Director and Deputy Director of the Research Laboratory

(3) through a special adr!.inistrative officer from NIB sent out for the purpose.

(The latter suggestion I consider unnecessary and state that it shoIIld be

                                                      w

possible for the Director and Deputy Director to arrange between t!lem for

the consigning of all cheques for the cholera work.  U.S. Government cheques
                                                             \

must be signed by an American citizen.)

0. and S. agree that the hlinister of Finance must he told abollt the

use of PL 480 funds for cholera but that agreement with the

such does not require their concurrence,

as

The problem of nutrition is not simple and J-ES does not insist on getting

action on this program at the present time.  0. and S. discuss the possible

handling of nutrition andHajrland funds by ICA,admitting that ICA believes

the activities of other American institutions in their field should be

curtailed. JES explains that the money caning to Pakistan on the University
of b?arylmd project is not NIIi money but university money bY the time it gets


-4-

here.  (MD chose Pakistan knowing it is a very difficult area; JRU chose
India (Calcutta), Tulane chose Col&bia and ? chose 7 )

1.





2.






3.

To summarize:

Cholera 480 money use will be reported to the blinister of Finance and

arrangements made for its usage witho:rt any anticipated difficulties.

Nutrition 480 plans are still nebulous and more details will have to

be worked out before ap;?roval of GOP can he requested;

;I!aryland University program is to begin with US dollar but may want

to use 480-104K money later; even though arrangements are to 5e made

by lid directly with some university in this country, there should be

overall agreement on the proposal between the US and GOP.  (It is

essential to have agreement which will cover treatment of foreign

personnel broalght to Pakistan and the importation of supplies and

equipment.)

Owens and Siegel are to get their heads together after a stud:: of all

available doc,Tments and come up with definite proposals (?I (1) some overall

agreement between NIH and ICA? (2) some overall agreement between US and

GOP? (JES insists it may be difficult to have another agreement between

ICA and NIH since the operating agency will be the University of Maryland.)

MacLeod, Smadel, Soper and Woodward drive to the BSMI and visit with

Paul A. Nicoll; P.A.N. suggests (1) National Researcib Council of Pakistan

be used as operating agency for nutrition pro-ram (this should he feasible

since h%CP is in the business of making grants for research projects);

(2) all plans in which rupees are involved should be set up in such a way

that the GOP will provide 10 per cent of rupee value for dollars or other

foreign currency purchase for needed eqrlipmnt importation!


                  " *' Y
MacLeod, S;TS, '%'\;f and N. lunch together at the Sind Club; hIacL. and TW

leave by train for h?aldun and Lahore possibly also 'Pindi and JES leaves

by PIA for Delhi.

November 30, Karachi

(1) To ICA - Owens out but talk to George Elmore re Dacca situation;

ICA Chief Chas. W. Edwards (Cal. USA ret.); Paul Schuler (Labor) has acted

recently as deputy (RR)jJemes Cassanos now detailed to ICA/Karachi (is

to go back to Dacca); Richard Towle, sanitarian, 3 years in Dacca (trying

to run a school for sanitariansljand Sam March, health educator. Health

work at the present time largely limited to jet gun vaccination following

the hurricane floods of some \\reeks azo (4 guns in East Pakistan and 4 in

West Pakistan).

(2) Learn that Caesanos talked with Major CI. Siddique (Te1.512691, Director

of the Nutrition Survej;and told hi.71 that Smadel was coming; but JES got

away yesterday without seein:? I\r.S.   I find h! . L; .  in Paul Nicoll's office


and immediately read him his telephone number and give him ilis title, all

from a paper in my hand, 0i.S. is small, wears what might be called a

caftan in some places and has a white and black beard.  Siddique was in

the army and carried o& the survey of nutrition in the armed forces here some

time ago and has jrlst been named as the Director of the Nutrition Survey of


Pakistan.  S. realises that he does not have the staff nr)r the organisation

to work wit;l that he had in the armed forces program.  Nicoll discXlsses


frankly with S. some of the problems which he must face if he is goinq to

be ably to use the money already    in the budret of the GOP as well as the


money of the NIH.  I explain tn N. that there is a proposal to have an overall


master agreement covering its modus operandi of special. research projects,


-6-

permittiny individual projects to be brought out under special agreements.

(3) Lt.Col. S. Ii!. 11. Bokhari has been cnarged with the development of

National I&oratories at 'Pindi; has money to buy land and get started on

plans; B. is one of the official delegates to thq cholera Conference next

week in Dacca.

   To the home of Dr. and h!rs. Nicoll where I have ca.n.ja and meet the

14-year old son.

   Afterno--,n of November 30.  With P. A. Nicoll return to ICA where he is


responsible for the expedient in the absence of Cassanos.  See I!'r. Owens

in the !lall and he asks for appointment later in the day.

To the BIJSI with Dr. Nicoll tn see installation oftbe Institute and

something of what is being done.  I am d lly im:lresF;ed; the !ZBT has six

departments: Physiolog:,;, L'icrobiology, Anatomy (Histology), Riochcmistry,

Pharmacology and Pathology; a library, cal,!entt-y, machcrie s!lop, Incireralor,

generalor, etc. , and animal breeding rooms all air conditicnec! (white mice,


rats, rah%its, guinea pji;:s, czts, lizards, etc.)

  There are an:>arently foreign chiefs of each section (2Yinten in Ziicro-

biology and Tucker in charge of tl:n repair SiiopS, obviously from Texas.1

P.A.N. ""y" rs{->'&,l students in each of the first t?vo clas::es:   the co'lr:;t

is a two year cocrse for tilose who should be tuaching in medical schools

soon.  Emphasis is to be on researci: mcthcds and rese;rrch tra'ring.  (The

BL'SI lo-~1~s like a very go.- d show; !'.A.F!. believes it is an exarple of hbw

ICA should work on every project.  BlBI is under a contract with tlie University


of Indiana. ?.A.;\'. says that for teachirg ICA should go   to teaching

institutions and cet t!,lere the organisation and experience; and for nursing,


-7-

ICA should go to a nursing school in the US A and contract to zet a school

organized over here r&her t&an to aid what has been done here--wcrkiw herd

(-i.A.Y. is not always popular with the ICA but I believe they respect

him and his j!id?ement.)  The F:irister of Health, Durki, was recently brought

trj the B!.:SI and was quite astounded at what he sa:d.  fIe asked how it was

pos:;ible that no one had evei told him of this development??

Return to hotel where Fir. Owens calls for me about 1645.  We return

to ICA where James Killen speaks up quite freely:  (1) he was not too well

impressed with the idea of haviny NE1 resea- ch projects started in his countryi'

(2) after talking with JES and learnir-I-r of the plans for staffing the Cholera

Laboratoryand the hld:~tropical diseases project, he has changed his mind

about these pro acts and believes t!lat these projects may well be t'ie means

of makinv the ICA health work stronger (3) he asks me to give this meswqe

to JES and says he is ready to heir, these two projecf~s in every way poSs;if?k?

(4) he is ready t- consider takircr a good young doctor to run the admiris-

trative part of 1 he health services if he can depend on ?:II: for technical

      (6j
pol.icy advice. n He asks if I an1 willing to collaborate as which poi-t I

speak up rather frankly about desiring not to hecome a controversj.al figure

between NIII, JX ,  and ICA.  (6) I give something of the story of the relaticn-

ship between the USRIS and ICA in the past and indicate why ICA has such

difficulty in getting and keeping the type of leaders we sho.ld have in the
                                           -4
                               14, ._.
health field overseas.  (7) I al- give a: story of my relationship with the

malaria program during the past year and indicate t!-:at *malaria eradication

is my chief interest (8) indicate that I saw little chance to contribute to

malaria eradication under present z&xxi stres:;es and was therefore vulnerable


-8-

when JES broached the cholera project. (9) I go so far as to indicate that

there is no financial incentive for us to come to I'akistan but that I have

been preaching for years on the necessity of taking communicable diseases

in their permanent foci of infection rather than try to control their

spread through quarantine (10) that HR are not playing for peanuts in

Dacca but lookit:?; for a breakthrough whic!l may result in frecinr; the world

of thi' disease (11) I indicate that I believe good men can 5e found to face

up to the challenge of foreign public health service if they are permitted

to work freely on imaginative projects, etc.  (12) I point out that I am

basically desirous of being helpfIx in ever? way possible and that also"x'l.t.

success of the cholera effort will probably depend on the op!or?:nity to

work witi; oryanisod health services in East Pakistan.  (13) I am therefore

ready to commit myself without committing the NIT!.  (14) JK icdicates that

his service and men are not among those which are run from Wasi:ing'on and

that he wants to work out a deal to take full advantage of WIIi

in tkils country.

After we leave JK, Mr. Cwens comes with me to the hotel and makes a

more definite statement re?arding JK's plans to get 711t of the box with the

lacl: of personnel from the OPH/DC.  (During the talk indicated that Donovan
           r-
     /--LCli >,
is an  nice' tierson but coasting.)

Owens talks snme details of plans for the future indicatinr: that under pressure

of reducing budgets this year JK had decided to concentrate on the RXSI and
                     % &&,r li;.+il. *i ,b. **> r;':&

on the training school for nurses and make these two projects good,letOiftg

other health activities await future possibilities.  0. asked me tl:en what

should be the next step.

At this point I took out the time to discuss "health centres"


-Y-

VS. unilateral programs and pointed out that most of our USA trained

xorkers in public 1:ealth have been taught to avoid the unilateral pro-

                           ic -c-c"{ :
gram.  In Pakistan both needed, our in its own place and at th? proper

time,


December 1

Dr. A. K. S. Ahmed, Professor of Medicine, Dacca

Karachi to Dacca; joined forces with Miss Jane Stafford, whom I have known

since 1937 at the airport.  Each of us does a considerable job of sleeping

enroute.

Flight 114 PIA:  0700 to 1320.  We are duly met by Drs. Stockard and

John Feeley.

To the home of Consul John King where I am to be during the week here.

Cases of cholera have been found recently just across the river from
                                        a-d L.&%.

Dacca and today cases have been found even closer to the city; t-hen half a
  p&+dt.C?j                           Who
mile &!' to Dr. Feeley. (Dr. Mansur &umwB4 arrived Back from the USA

a few days ago has been out investigating these cases.)

December 3. 1960. Dacca

With Drs. Stockard

and MacLeod, called on Brig. Hyder.  We find
                                    /  , 'r     4Q  /a f-
                            5 :a. )  Quip  I I ( (`,.,., : 1 &',.pz.~~~ .d&.m t .~
                                              .* "

Dr. Helwani, Deputy Director, Regional Office of WHO, inLand an engineer

of WHO there ahead of us.  (Also Dr. Ahmed and Dr. Malick were there).

Helwani and I bring the discussion round to the subject of/yellow

fever\&adicati~~~~~,&pheles
     y-.-------- --   Zambia+
               ,yr
             'wu"             I;
        !ttkis?        ')\L\?
   To the P.X. with    A.S. and- the manager who says she does not

have a list of items but has only a card index. She says the selection

of articles in the emissary varies greatly from week to week so I decide

to bring out just the things that we like best.

To the %4Matqyonce more, this./time with Dr. MacLeod. Suggestion of

some sacks of calcium chloride to lay the dEZst at the Research Worntory.

Question of where the plaque referring to the dedication of the laboratory

of the SEATO should be placed; discussed with Kyder and Raque before a


decision is taken.

   Dr. hf. Rahman:  Studies at University of Illinois with thesis on


cholera vibrio (nutrition) now with the Davis Chemical Co.
--I -..

   Dr. Ataur Rahman, University of Michigan now in charge of cholera

vaccine production (MD, ?.?RI).

If hired, how corlld we qet money to pay decent salary?

December 3.  Dacca


   In discussions with J. Stockard, it becomes apparent that many of his

problems are those we have had to face in other countries    with other

programs.

1.  Adequate salaries for national scientists.

2, Transportation for national staff.

3,  Administration of cholera hospital - Nurses number7 qualifications?


4.  Character of cholera effort? Truly regional or partially so?


   Bilateral? USA and Pakistan?

5. Suspension of all :JYGkI positions not r-xxv filledfY Hence now no ICA

representation on Advisory Board!  James Cassanos, Richard Towle,

Samuel 31orch)"Xr. Towle is a sanitarian who has helped the GOEP

build up its sanitarian s:cool and has also travelled widely in

East Pakistan, using the high press:lre injector in fighting epidemics


of cholera"!!  Towle now interested in program for sanitation of

villages with Bored hole latrine.

  "We are ewer to provide assistance to the limit of ollr capabilities

when there is a GGEP program to supplement."  The M dbove is final sentence


in paper prepared for GOES, recently by ICA.

! After present terms present incumbents will not be reapjlointed.


hfemo (Tuly 22, 1960, XI:-!/ICA responsibilities.  Paragraph 2 of Section C


states:

"ICA will provide necessary operational and policy guidance throllgh

USOWPakistan.  The Chief Public Health Adviser, Dacca, will participate in

the project and, to the maximum extent possible, regular ICA medical and

public health programs will !>e coordinated with t!le project."

(Under date of October 21, J.C. indicated to Edwards that senior tech-

nician would serve.)

Pecem!.J. Dama.

   Dinner at the home of hlr. King, Consul General of United States.

Sopher with beard (of Arab extraction but admits that the name Sopher is

of Jewish origin meaning teacher (7) S&per, sophir, etc.

   R. N. Phillips, with beard, and altered personality!  h!r. and Mrs. Blood,


Mr. and hlrs. Senna and many others.  Those at the dinner were Consul General,


Bloods, Stockards, Sennas, and hIacLeod, and Miss Jane Stafford.

After the party breaks up, h!r. King and I remain to take coffee and to

talk.  This brings about a discussion ofthe type of organisation which: we


should have in the PSCRL:  K. wants what I do, namely, that this should be

scnnethi*lT more than an ICA o,peration; it remains to convince the US people

on this but the British have already brought up the question and others will

do so later.

December 4. Dacca

   To the airport to meet J.E.S. and find the Thailand delegation including


Dr. Bin and others I have known. Also Dr. Black from Australia.  (I learn


from Black that he is interested in having some of his people cOme here to

work with cholera).

J,f.S., John Porterfield, K. Goodner arrive together.  J.S.S.  and J.P.


come to live at the Consulate.

I learn King, the C.G., has worked in E$ador, Argentina, and Uruguay,,

has had a year at the War College and 3 years at the U.N. with the USA

delegation.

In the afternoon to the laboratory where I find Dr. II. E. Shortt and

others re-united to discuss program for the Cholera Conference.  Others

present are Porterfield, MacLeod, Goodner, Smdee, Phillips, Shortt, Stockard,

Malick (U.K.), Woodward, Alansur, Feeley, Miss Williams, Smallbones.

15 minutes summary of what went on in our session.


Dacca - December 2, 1960.

      J.sh(. Stockard :  Question of vehicles for ICA advisers w

is one of difficult problems with GCP.
Govt. Guatemala Bldp,

Each member Government -   ny7.500s

Ati. = PAS3.
9 ir. Council = 1 rep. each member country.

          = Dir. P~233

Dudgets -

fipproves programs,

Administrative Procedures.

       = Reserves for pension.

Grading positions.

establish salaries.

P.I. U.K.  Thailand,  Australia, U.S.A. Pakistan, M.Z., France.
                 yoo, .33t2. c:a.
       i  i-.l!;I:
? o ? ? ~lO,OO$XATO Charter to NIH  ~,,Contract with ICA - Contract with

Government of Pakistan. -    FL 480d~ior1(2e I
                                       L -'irx~~& I< _ /p#


Meeting December 5th : 1i.d. Phillips, KacLeod, Smadel, ?ioodward, Gotine??,
-.             -

Stockard and Soper.

Six months objective:* Bacteriological 1aboratory;complete lab. for diarrhea1
disease$;g  Serology cholera ( Diagnosis )    \ \ y ..
                    *k,y-*' i:
Capacity to store isolates for future %x;-"in $&
     ( N&sur has fluid for 3 days from lab.)

Nonsur should traih one man for freeze dry, Freeze dry on first passage.

Type specific antibodies to organisms.  :,!ho will relate isolate tc clinical

story.  I%.nsur has to save something of everything for K.G. checking.
                &J;:

Let us get collection of e&l vibrios. 'i&at is a case? Zhat is cholera ?

Laboratory is basic tool.

*Rise and fall of vibrio population over season ( Lucknow : vibrio +
      1)
bacterioplage = cholerae .    K.G. is interested in above.

--

.        '&hat do we want ? Dry land area'less than hours travel from

laboratory.  Cockb&'proposed (1) 5 mile radius of Laboratory for all types

of conditions - Should be started at one place or two places ? X3&5X 3X%

Kutritionsl studies essential.  Make longitudinal study of populaticn where

cholera may occur in future - then study when disease occurs.

ii  Wahed is out of Govt: put on c:>nsultant basis.

        II
Fill hospital; treatment and train in treatment E
t&h li'L(

(.4&+-E& interested in say 3 cases a week to study )O

Gcuestion of Hospital; to take or not to take.

December 5th, Dacca, Zast Pakistan :

          Dedication of PSCRL -
                             --  red,green and white decorated pavilion for
hundrehs of persons. ( I talk expansion and internationalization of ZSCRL

with Dr. Black of Australia and Dr. Bull of U.K. ( Dr. Black is apparently

frcm the malaria surveys of Australia.)

     ( Koch 1583 vibrio in Qypt )

                                                            ILLCG I
I met Kr. Korth, the Deputy Secretary General of S2ATO 4 make,arrangements

to see him in Ijangkok af-ter this conference; to get a better picture of what

SEATO is.

Dlack speaks for Australia at inauguration. Australia cooperates where

possible in SEATO.


Dr. Pin. of Thailand = 8 Epidemics in last 20 years2 ( Bangkok, May 23, 1958 )

mentions as objectives the eradication of Cholera from the world0

      Adair>U.EC. High Commissioner, d a1l.s zttention to $10,000 contri-

bution and that U.K. is member of SZATO and interested in real international

ccopecatioc in the common good.  ( IQ government wishes to contribute

and to participate!)

Kinrr U.S.A:  8 countries - France, Japan, U.K., U.S.A., Pakistan, PI, Thailand

and Australia.

Porterfield - U.S.P.IY.S.   Cnoiera was first problem on wi;ich USP;iiS undertook

research in its early years.  JF speaks of Cholera eradication.

Dacca,December 5th, Afternoon Session:
      Dr. Pin opens the afternoon meetingx with a paper of Dr. A.L.Y.

Abdul '+?ahe d, t  Department of Ilealth+3ocial TJelfare and Local Government, enti-
tledx Classi& $inical Disease.  ( The reverberation is such that >:::ile one
                 c
rndy understand words, the sentence structure of most of the sen{tences is lost.)

Some of them are found inefficient: our experience has been just the reverse;

&?hillios -  Cholera can be treated with unspecialized staff &k& salines
and bring6 mortaiity%ery 10~ ( 1958 Bangkok 6% ).
         Symptoms are minimal in cllolera cases - thirst much less than

in dessication in the desert.

December 6, 1960 - DBCCA:
Zm.
jL$.  Session.  &Physiological changes in cholera. Dr, Lee X. Farr>Brookhaven
                                        - c; 0
National Laboratory, 3I.P.:Iuclear materials not/much a tool as a discipline *
                                                                           J

must be careful to go to the patient rather than draw conclusions in the

laboratory,

F. refers to Dr. Yan Slack*used same approach to Erig:ltls disease

as had been so valuable in diabet&.
Danger of fr&mentation of problem; i,,I;, (C. ,
                  %-<&se,) study the patient as a wholel

Temptation to break down problem into its oomponent parts.  Gives m example
                                      i .

in case of anemia bhere study of  t,: f"' t .       ,'      1
                                             ,*'a 1.   u ,...L,, :
                                                i   . riir1 * *

      I_
`2 dM%4
i    b-4 i &g& ,?CG c G ~~,.~-&g---i I-9 : c-T{ .
                      i    t L5 )I,
    "                              _.II
         F, gives examples related to renal blood flow. Capability

patient may be quite different from the condition of the patient's a


'Jater balance in &'L~*~" of body could not be studied before isotopes

I J c-
  LI

  i
I 1
J

were available,

Sodium requires hours to come to equilibrium when balance

is disturbed.

i14: Farr contd.
--      Dec. 6, 60 - Dacca.

free acid in

Secondary %

Amino acid entering cell is metabrAized immediately; never in

cell.

Observation fields.
Yotility Transit time .
5
p' ecretion - Afferent blood flow,

Absorption - (f) Transit time and Efferent blood flow.

Renal function

Circulation competency.

Digestion.

decreased because of above factors without loss of function.

%P draws mechanism of kidney and gastro-, 'ntestinal tract on similar basis

with regard to movement of liquids. ( Surprisingly Similar.)
     Proposes that we study 3.1. tract as Lh% uL~(2 t-% (,A: j%,F.,6 ,
                                                                           t

Inststs that G.I. picture has been building u;, sometime before it becomes

aj3parent.

L3F suggests that material frcm SIT comzs to liver then to lungs

and finally may be found in the expired air.

LEF then gives diaC;r:m of various method:: of using isotopes tti

discover many different changes which occur.  Eeasurements can be made in

stools, " bv tube in body)or an automatic resp5,ratory e,uip-lent -Aich will

measure ex;;Lred. isotopes.

       Kust study entire patient.
Cholera and Sodium Pump - G. S. Huber, N 1-l :il I L*!
Concentration rslations of electrolytes w in plasma and cholera %X&$ excreta.

Dr. R,LO Blackwell ( I$&RU 2 ).
          The dehydration of cholera; therapeutic implication,
Capt. R.k, PhillipsJ    i;AJ:yyJ

    (1) Replacement of fluid,

(2) Volume for initial balance.

Volume for continued balance.


     I 1311
   3
Dec. 6th Continued :

How establish rule for fluid intake ?

R-3     Failure of acute cholera to give rise to exudative enteropathy -
3
L L 1 &.'Cordon Jr., NIZ.

IQxithelial barrier not broken in cholera.

L4add-bb 7. /9647
      &, Goodner -  Vaccine is 67 years old
a$.;& .& a good field test. (1) Public &alth workers are apt to

demand vaccination.  (2) Scientific workers did not believe it will work,

Daizo - Ushiba Keio Universit:>Tokyo.   MO cholera since 1946.

     a Statistics indicate vaccination was of value in 1916

TO&O and 1920 Osaka - but K.G. t                                    c
                          ails attention to the fact that vac$n es
                        . k

were self selected.

Dr.  kzurin,Quarantine Service of Philippine Republic.
Vat. began 1908 = vaccine made with non-motile organism,  Today the ?I relies

on Clunrantine.

  (, 7 ';.C jj. 22:
&, Bin, Thailand -  20 million vaccinations - Believes 1959 curve altered

by vaccine.

   0)
ii .G. (P+st area in which new clinical strainr j, were put in vaccine from

week to week.  (2) Used very fresh. )

(1) Use fresh strains, ) Recommendation of X.G.
(2) Use fresh vaccine )

Dr. Gallut - France.
-

     Reports on vaccination - In Indo-China.

Dr. Hussain.

Dr. Srrndel -  No one would refuse to use &@
m No one would rely implicitly on iisf$

Present (1) Vaccine and (2) Procedure.

John - Mouse-protection test for cholera vaccine.
Vary vaccine 2 constant dosage ( Challenge )
Vary dosage ( Challenge ) - constant vaccine.

'&IQ standard weaker tha; NIH - *Probable loss in drying.

Ogawa - not good against IXABA.

Irtaba - good against OGAWA.


Nouse protection test good method but what does it mean in% relation

           UN&\>%.,
U Shiba - Keiovm Tokyo. II

      S. enteriditis   Serum studies - li$e and killed vaccine -
       ')             --- .^-
Ataur R&man                                                    p/
Dillon - cable to Conference - ,XRK would not have presented to ahd have been

signed by Secretary M6 of State at least.

K,G,  Says that amount of vaccination does not give enough immune body

substance to immunize,  Is cholera a local or a general infection ?

Comparison with Polio,

/    :.
_    Are there antibodies in convalescent sera ? 1916 positive results - but

then not confirmed - now K.G. says immune bodies are developed.
   Must use live organisms in agglutanation test - best with fresh

vibrios from current outbreak -

All confirmed cases show anti-bodies:

Some patients had antibodies on admission-j with cholera.

Immunity group or type ?

Ogawa antibody not on admission but during convalescence.

K.G. has worked on 20 cases of cholera an& 60 cases of non-cholera.

Only USSR vaccine had Ogawa antibodies among all vaccines sent to Thailand -

USSR killed with formalin then phenolized.

Colin MacLeod -  Story of Lion saying grace - are there second infections

with cholera ?  Does immunity explain periodic%y of outbreaks ?
   Longitudi&l studies with diagnosis of all diarrhoeal diseases, 1

are necessary.

-.

INTO true background in animals ?

Studies :  0)

      (2)             all diarrhoea diagnosis (1) bact-

  eriological and (2) serological.
(3) Random basis = using TAB for control.

(4) Intervals - rr;iliti?le doses 3 with '.!I I_ ' "Q ' /of 4 to 6

weeks before expected epidemic.
(5) Size of group z Cannot be large - choose .a_czssib;e area.


(6)      Some history of past.

(71

Carry forward longtime.

(i-3)

Au%+  bleeding,

       jJirzapur - 42 miles from Dacca

                                        5,           ;,i,ir>it 9.
     9')O bed Hospital - Bela q$zar, xeroet,MZFEa &secondary to
         &.x$./*As &p.,B4.~ : ~:~~q=d&b~~~ m&-1- ""I 'L.L;2h`L
amoebiasisf, rheumatic fever -  over
             44 4   530 girls in schoolr not cancer+etame.

Na,j or
14. Anwar at Govt. House.  (Promises 12 mont& good weather - all in

November, December and January).

hlr. Abbas - Rep. of Phillips, gives autolift.

Dec. 7th.

KG:

Is cholera intestinal or general disease ?

How resolve vaccine problem ? C FcL presents procedural outline.

Hii; Sncrtt backs this outline,

        Agglutination test CK hith live $ vibrios!
r Tc cholera TUards at&tford Hospital with T\; and CML =

/

i Ky first cholera cases; 10 men, 4 'women, ( 65 cases in Xovember-every month
i

j has had citses XX%& in past 5 years! )

1
i
L

  KG
  =

43;: of cases from city itself.

Sma1113ox present - not seen.

ReDsorts
  *    et Lucknow Drug Institute.

Shrivzstava - Antigens of V.cholerae.

Dhashran - transformation of non-cholera vibrios to cholera vlbrios-

IfArzapur &olora ftosc;ital: I:'ednesday - December 7th, 60, Dacca Z.?.

(1) Korning session with KG in the chair : rl T 3s ai+;ayfj a M-CL i ,~.~B~  job.

3aiseJquestion of intestine against general disease.  .rilsC        i'
                                                asks how vaccine
\  grobiem can be resolved.  Mscleod. sets the standark.
:i
,a
ii
':        I(G tells of posii,ive agglutination test with ilving vibrios,
!' Shortt backs up ?!cLs pl$.

(2)      Tc cholera hospital with 'fl!! and CX#EL where we see my first cholera

case, SOme 1C men al?c5. 8 women, Learn that there have been 65 cases in the month
of November and that no month for the last $ cr 5 years has falied tc register
Cholera case, ,!+G:jJ cases in this hospital are from the city itself although
none are reported since otherwise thc%$ort might be practically closed down.

-kiSO learn there is a good case of smallpox tc be seen.


   fi&   told me to come to tile hospital and girls school at the

country village.  990 boys, 500 girls in the EX school xith 4. L.-KAT. ;51"
                                                                           :.

of abcut six million rupees.

In T-iospital, we learn of Kalaria (TIT) fairly frque:,t; &la-azar

c c a se., clay p' ), (" '*-a b'%L ieprosy);Tl.heumetic fever> secondary &id.iad
                            * k-,      4
                                      to infec$ scabies
     -9                          r\i7
lesions; cancer, due in large part to betel GM chewing; tetanus common; expec-

tant treatment best; xerothalmia iniith resultant blindness, secondary to amoe-
              JcldJ-mwG-

biasis in which gut does not,proteins and vitamins :
       Major M. Anwar  State iiouse with Governor.
    Return with iI.G., iiasz&sen, GOTdOIT, ;;alcott to bridge where

Nr . ,Ibbas ( Phillips ) i;icks me up;home 124;

      Impprtance found in history of cholera; Pakistan, S&'J'[) and idI,Lj,

many of us would like to work here in laboratory.  Document !~ill. be made

                                     $

milestone in plannixg:;uestions rather than ansxerk.e-them.
(1) 5 ractical treatment of cholera.

(2)      Anthropological problems not fully considered; must be taken into

cxisideration in handling cholera in the future,

(31       Socio-economic status has been associated with decline in CL in

i.estern countries.

(4;      Speaks of xorK1:l, P together in eradication cf cholera as a means

of getting better interr;ational understanding ai;d collaborat&on.

is>        3csires to con inue interest in work.
             Fr

        Sallut,

Prance,

Deep appreciation to

         'Jshiba -  Japan :  Ap;rcves idea of all countries participating

in effl.'ort tc eradicate  cholera p all Eoctors agree with Japan;must continue

to stud:; and igar& to collaborate in the futwe,

3r.  Az~rin  i" . 1 .

Good meeting covered wide areq: b&K eradication programs - malaria


and smallpox ( tribute to American workers )            1955

1960.

     ( Thanks to Pakistan Government for this conference and hospitality.)

Dr. Bin - Thailand I  Paostly platitudes.  Thanks to everyone in SBATUj ICX,

NIH, NAMB v , SEAT~~Pakistan etc. etc.  Mentions trip to Mirzapur and accident

enroute.
   Kahn

Dr. ILp;IM tells me about the problems of quarantine with India this year.

                                                                         LL. c 4 cr.
                                           -c
At first no country established limitations but India officially &o&&on

against Pakistan which forced Pakistan to take action against Indian passen-

gers; the difficulty became one of how to isolate and pay for food for

soma many people.

, -,,'       Dr. H.E. Shortt - UK - returned to scene of some years of rewarding work.


\           Conference;                       from all countries in

SBATOtarea; still are to learn in practical application

eradication of cholerat they doubt it can be eradicated
,t=%#~on long-term studies on vaccine even though answer may lie elsewdhere ~

in general sanitatton mf and betterrwater supplies ? Who knows ? Most

important and best equipped laboratory on cholera in the East.

    Thanks to gholera Advisory Committee.
                        f
Finally I am glad to report uWh-------."~- --ah& gift of 10,000 pounds for more

equipment for laboratory.
               ---w.J+            4 ,I<.!./
          All    iu%eca.l~~~~~every success to

Dr. Soper, my old frlendj,who is to be Director of the Laboratory.

        Joseph E. Smadel t. An amusing experience to find out how many

people are interested in Qholera and willing to work in final solution of the

problem; namely eradication.

f. --?
II

Dr. M. Siddiqui Hussein.

December 8th - Daccat

(1)

made.

To luggage shop on first attempt to shop in Dacca; no purchase

(2)

Conference Session on Vibrio cholerae; laboratory identification.

K.G. talks about vibrioses and variability although he insists on

the unchanged nature of the clinical picture of cholera over the many decades

of its known existence.


K.G. Vf$ffi began with the classical strain long

in the laboratory

but now has a museum of some 500 strains.  Variations are sensed but often

difficult to describe.

m      Prof. J. Gallut of Pasteur Institute,Paris,is difficult to

understand but not too far off base L i.6 :I_- ' l    words on cholera.

(3)       Lunch at the staff house; [l 'I.,,           the early

association of JES,Farr, Bob Phillip, K.G. and Colin l&cLeod at the RI

many years ago*

Later in the day,he$ the story of the Horsfall and Weir,#oof-.Lr(

in reporting the reproduction of atypical pneumonia in the Mongoose. This

resulted in great expenditure in time, staff and money during the early war

years in getting animals from Jamaica and proving them wrong*

(4)       Closing Session of the Conference; most of the sunrnaries are

well done.  M. Siddiqui Hussain speaks for the Government of Pakistan.

H.E. Shortt announces the gift of ~.lO,WU.00~

I take advantage of the PI ( AZURIN ) it complaints against present

quarantine regulations to point out that quarantine itself is not the answer

andthat the PI and all cholera representative countries should be cooperating

financially and scientifically with the PSCWL ( Pakscrelab >.

(5)

To the Government House to mshf have + tea with the Governor

M. Azam Khan to whom I present my apologies for not being present at the time

of his visit tomorrow.  The Government shows interest and promises of support.

(6)       K.G. organize party at the staff house; Shortt, Wahed, Hyder,
Hussain, Huq, Bin, Azurin, Prameru, Bl$k and others present; Towle with the

w&&+& music and C. MacL.leads in Alluette. ( Learn of C. l-ifs. C1$#$$$&l
                                               --

   J                          "
virtual disappearance of the IHD. J'
(7)       Left six shirts, white dress suit and 4 light white suits in one

of the Stockard suit cases.

December 9th - DACCA TG BANGKOK.

(1)       Farewell to Mr. N.B. King, American Consulate General in Dacca.
                                            I^,              far A
( N.B. King is trained as an economist; Kii-% Lc."-tt, service in E&l&~#rgen-

tiy,and Uruguay; had 3 years as economic adviser to the USA Mission at the

United Nations; then served with the USA Mission in Iraq at the time of the


h
Bagffad Pact.  Also it seems he had one European appointment with the State
Department.) ( N.B.K. makes us his house guest except for tips to boys and

laundry.)

      N.B.K. says that he had to sit by and see all of the early
projects of the Badad area become just so many ICA bilateral projects;
he believes there is a place for bilateral projects but also believes we

need multilateral ones; says we should begin now if we want PSCKL to be

multilateral.

(2)      After arrival in Bangkok learn from C.Pease that the PSCRL
has an entirely unique position in all USA projects because James Killen

USUti Chief in Pakistan,refused to have anything to do with it.  It is based

on an agreement between the USA and SEAT6 and then on an agreement with the

Government of Pakistan, not the Health Ministry, since provision had to be
                          -
made for many privileges for the Laboratory.  ( C.P. says that J.K. finally
changed his position because he did not want NBK to have anything to do

with any project.)  The position of Pakistan SEAT6 Cholera Research Laboratory
                                               Qph '.

is then already a special one which may make it relativelyX )  t 6 make it a

multilateral project.

(3)       Clifford Pease reports that CENTU,with Headquarters I(tfil)d in
Ankara,hasag#6ecome 18 a very active multilateral organization; CENT6 should
       qd..+

be studied to see 'khat may be useful for us in our relationship with SEATO.

                                         b I !<:'
(4)       Lv. DC. on India Air and for lunch in Calcutta ( Dun; Dum Air-

port > with Jane Stafford, Bob Phillips and Lee Farr. Dum Dum to Bangkok
             ee4

by Qantas in st+rage with Rasmussen.

      R apparently from Medical School in Wisconsin; intesed at Bell
b4          c'
Q'tv'W' '"hospital in KCK; then to armed forces and L;C'r'LL"C
for aLyLl:L ; is now at UCLA ; apparently a temporary duty with N$mru 2
                             Z
in Taipeh. ( We discussed, among other things, Polio virus vaccine.)
                  p/J : r,' .
(5)     Chinese dinner at the Eaa=s'Kestaurant; TW, JES, KG, FARR, Pease,
          /f                       >
C McL, FLS and%@ to $x8x bed.

(6)         Befor  the 'I to bed IV
      'i 4.
                 rb      movement I learn from C.P,,$hat malaria
              :-$q=-'                  ~~pv%.`d
here is really in s-l-% shape; wi& the '-& \ c,c', j
                          never really ti in for eradica-
                       !'. 1:. ~1

tion; that the house spraying is to be' faced out this year;  that malaria is

on the increase and that difficulties are very real with a ###Ld$8 series of


&changes imminent in the direction of the Ministry of Health.

(6a)    EHH report on malaria in Thailand, November29th made available

to Dr. Chas E. Richard3acting Chief PH Division; Mr. 2. Smith is malaria man
here nowj Dr. S. Avery-Jones and Miss. Louella Lowry, WHO; Dr. Udaya is the
                                                \
Thai Chief of Malaria. '

(A)      Malaria has been practically eradicated from the great central

plains of Thailand.

(B)

**The foothills" region and the Southern Peninsula still have a

distressing amount of malaria" I  ( A. J. reports as high as 40 to 50% of
positive children in hills with 7% in the ##$+I! rice growing plains but only

2% in plains among those %fi not having slept in the hill$ areas. Cases,
0 iwbA#hd
D&o most often in unsprayed houses, which amount to 10%.

(c>     A. minimus disappeared from the plains areas; in the
both A. mimimus and 2. balabacensis transmit.

Once a year spraying not enough in hill areas.
Administration problems; financial problems; lack of supervision;

        lack of surveillance.
                      ~(ihL';i'\-
Ii  i 3     0)      Excessive Civil w requirements for training of malaria

personnel.

(G)

Premature cessation of spraying.

Under Secretary : Luang Binbakya Bidyabhed.
Director General,Department of Health; Kamdhorn Sgarnakich.

Malaria:Dr. Udoya.

Mr. John J. Conroy, First Sec. Embassy Bangkok - Mr. Lewis E. Gluck, Spec.
                   c Q v
Assist. for SEATO affairs, Bureau of &z. Eastern Affairs.
                                0000000000

Dr. Ambhan Dasaneyavaja, Dept. of Pathology, School of Medicine, Chulalongkorn

Hospital, Bangkok, Thailand - PA - KAW - MA.
                                000-0-0000
Dr. Kasorn - Med. Director.
                                000000-000
T. Woodward story of Carrgll typhoid - Carrgll of yellow fever work y died of

typhoid vaccine.

11th December - Bangkok :

I / #: c.

(1)     River trip with Dr. Clara Nigg. Dr. Ambhan* KGs Jr;s* Lee Farrp Pease

Colin,     -7
    MacLeod, fed Woodward and Dr. . . . . . . . . (Thai).


(2)    ClFa Nigg is here working on ti eliodosis, a human disease

which is somewhat similar to glanders.  It is a highly fatal disease, 95X, of
          after
short duration ff/diagnosis; the disease may attack any organ in the body,
but seems often to be mistaken for tuberculosis. Few of the cases are diag-

nosed but there must be many more since contagion in the family or in the
hospital is unknown; it seems that there must be almost universal infection
only

with/a few cases in which there is actual invasion of the body tissues with

the production of disease. CN has been able to develop a CF Test for icirbi-,li..; '13

which remains positive for some five months after the acute infection and which
                                 tion       sms
can be given a rapid boost  by an injec-/ of organi&&#ti&# lat   r.

      CN is here apparently under the Army,or rather the Department
of Defen e,since
   8     she works in a Yaval Laboratory in San Francisco in connection

with the University of California.  CN has been finding difficulty getting

diagnosed cases at the Malaria Hospital where she is working; I introduced

here to Dr. Ambhan Dasaneyavaja of the Department of Pathology, School of

Medicine, Chulalonjkorn Hospital, Bangkok, who confirmed, in the laboratory,

the diagnosis of cholera in 1958.

Later at the other Hospital where stands the statue of the King

to which we paid homage, I introduced CN to Dr. Kasarn, the Medical Director

of the Hospital,who said he had not known that CN fs here but would now do
                  -I. i`

~' everything possible to help herdAthe information and cases she wants.)

After the river trip to the Temple 6tem#& of the Dawn, a

truly imposing structure.

(4)       To the Hospital where Dr. and Miss Pin assisted Drs. JES and KG
place wreath of orchids and present a silver plate telling of the act. Met

Dr. Kasurn aqd Dr. Sevati ( Dangsvang.j

(5)

Lunch at the Erewhan with Dr. and Mrs. Pin and Dr. Ambhan as

guests of the crowd.

(6)

To PAA; ask for room at the Clift Hotel,SF,night of 13th and 14th;

and reservation to DC,on the 15th.

(7)    To thexmple of the Emer$d\ &&J-d b s 1 with Farr,Woodward and
KG; then to theTemple of the WiDgil Golden Buddha.

(8)

TW tells the story of what happened to C&roll of the Walter

Reed Group who died as a result of infection by a supposedly dead typhoid


j , -* (6       organism ingested during expdrimental work.

(9)       McLeod and Phillips discuss possibility of human experiments with
    &L&Q 4. x
    + q ML is against, KP in favor. ( of course, I am neutral,
                            I
                         --
I see no definite ob 3" tL.4 -\  tow human tests at this time.  RP believes
that only poorly nourished individuals can get the disease.)

(10)       Discuss with McL, RF Group: Harrar, Theiler, Morison, Coggeshall,
Nelson, L$eb, Berry Wood, Oliver McCoy :
                             A
     Need for st#ff scientific 'gacking in US and stiff scientific work
in the field.                                                   -
       $
        Remained Bangkok till 13th.
             :>"G (  '
                 ,ri * rGY -( @.$ $c .:. f J&)                        9, f
     '--On 12th visit to cholera laboratory, to Director,Health, Amba-

ssador, Conroy, Sarasin- lunch with W. Worth.

000000000000

Dr. Henry Darner, 1835, Eye St. Washington D.C.
                   000000000000
# J.K. Wiggins, 2218, w?;; Toming /!vG.~N.W.

,  `i <'
i 1

Washington (8) D.C.
     o-000000000

Chintamye &tayakal, Director of Economic Services,
                    00000000000

L. Hald, Acting Public Information Officer, SEATO, Bangkok.
                    00000000000

Discussions Population Growth :

(0

Nic&J- Dam Builder in India last 15 years =

(2)

Kittsman, Phillips 66 - Oil Field Developer.

00000000000000000             . i

                                                    h'r'li.,. `,~,&e.
December 13th : Discussion withz:c`ii Tokyo Airpzrt; with K later on plane.

                                _0000000000000     n-t
        N came to India with bleeding +t2 !  It bleeds no more! Increased
food from irrigated lands brot under &ches cannot keep up with population

growth.  Recent male castrations are only for money payment, not from desire

to limit population.  Priests say we cannot take from the coolie his only

pleasure.  N. is discouraged as to possibility of getting population upto
               ^

point of wanting something better.
                               0000000000000000000

K has not been in India for 15 years but during war was all

over the lot - Burma, China, India - like N has a sense of frustration, does
       /1,-,; .          2 d k ,
not believe with education - catch up with situation.  I preach doctrine of

hope - Japan, Ireland, France, Italy and USA, and insist on possible rapidity

of action once results begin to appear,

December 12th, 1960 : Bangkok - To the Cholera Laboratory of Oscar Felsenfeld
where we also see Clara Nigg.


opinion

0.F. speaks in such a low voice that I get very little of his

m; the recent outbreak he studied was of some 400 caseSwith over 100

          CL?
cases in hispital; no , < ;?p=J &LA', 7- ;. "' 'r, .

We call on Dr. Kampdom Suvamarich, the General Director of Health.

To the Royal Hotel where we are guests of Mr. Wm. Worth of SEATO.

Afternoon schedule called for;=-modified by the sudden flurry

in

s part of the world requiring a meeting of the

representatives  of SEATO countries.  Late in the afternoon we call on

                                            G
Ambassador Alexio Johnson; AAJ says I am to be under b,)ib L'k1'7in Karachi

for administration purposes but that for SEATO matters I should work through
   L, 547 +/?LT)L&

A&J. AAJ sent-past: to individual &$&!1'LCl country action by FLS, thr#&  .'

7                             !.;.c :I:;
2 y!.?t. il. f k-1 2
  b    ""k, " groupsdust so he nee& what is going on.
   ,d'                           --w---w------
December 12, 1960.   Dinner at Palm Restaurant 45 Bt.

December 13th - Call on Pote  Sara
          % ? in,
f\ 0.k &-( c ,J.&.&.+        B.. P . ..L.~&  he believes we should be ready to make
       I J  does not&we can go  7
                              fast in development of multilateral

organiaation.

Lv. Bangkok 13th Ar. SF 13th - Ar. DC. 15th z

DECEMBER 19th - Washington D.C.
Tel NIH : (1) D. Parkinson takes over travel account details with air flight

stubs.

(2) Arrange to see JES at 10 a.m. on the 22nd ( Thursday ) to fix up

PL 480 document.

(3) Borrow sound@criber from NIH.

    (4) Talk with D on Simpson regarding certain political uit consider-
                      '
ations ( `5 -Q-d.,  is meeting with the President of Peru this month at

the home of Dr. M&laga who is a brother-in-law of Prad& ).   .

(5) Lunch with Oswald? da Silva at the Cosmos Club;   ' lrzi '

problem comes up with discussion; I refuse to get involved insisting that it

would not be fair for one in my position to act in any way.  I do, however,

express the opinion that if S is to be an entry in the race for Director

in 1962 that he should resign at a proper time.   .
                                        "i

(6) Medical examination with C.H.R. Holley:BP 130/74 wt. 201 lbs.

(7) To NIH _ Gene Campbell reports on trip to Mexico and the Int*
     -m -


Am. Fed. of PH Bs. C says that M.E.Bust&nte do not participate in discussions;

that there was no action of the Mexico Government regarding the present

Federation; that no evidence of any vitality of the 1952 movement appeared.
On the other hand,there were informal discussions with representatives of

several countries including Mexico; one interestirjg proposal was for AIDIS to

take the lead in forming the more general organization. ('$F. Mat&on did

not go to Mexico but made EPC his representative. >

(8) Talk to Bray and Keeny regarding publication of Bawl report:
                         YCd,

present written comments of FJB's letter and on Paul Bea&r's editorial

suggestions, I find it difficult to have report rewritten as an ICA pxq

propaganda document; FJB says Mel Griffiths says our statement regarding

Thailand is not true.

(9) Check Thailand statement with Roy Fritz who agrees it is a

proper if reserved appraisal.

  (10) Discuss with H. Hinman the Publication of P&?&port and MG's

responsibility tothe Thailand paragraph; HH says he thinks MG's attitude may

have changed after talking with HH this morning. ( When I comanent on MG's

becoming original adviser on malaria in South-East Asia, HH indicates this is
not important, since (1) ICA does not have to do what MG advises and (2) the

main malaria man likewise does not have to pay any attention to him1 )

45 minutes from ICA to Cosmos Club by Bus.

     (11) Call Dr. Arthur Hollister regarding APHA force.

DECEMBEK 20TH :

     (1)      Call Howard Kline ( WO Ex 35381 or 22833 ) regarding WHO

Fellowship Committee which is to meet February 1Otht Since I ir shall be in

Pakistan I write to BJ Mattison to appoint another representative of APHA.

     (2j    Call Jack )(Weir ( person to person FLS expense 1 (ai
Decidedly negative respor$ to suggestion that G. ~i.(*~~.~~*'~~.*: might become

Director of Sanitary Bureau. (bj Name of KU Ernani Brga mentioned but I

po&nted out that EB is Brazilian as is also MG Candan. ( In enote I
mention names of Nevin Scriashaw and Arngldo Gibaldon.               him
                                  (c> Jmw assures u that

DR knows about his opinion of the present Director of Pan American Sanitary

Bureau; now working on Cholera, (d) Assure JMW mxxs he should call DR*s atten-
tion to ability of Kkgc
                            .


(3)   Write following letter to Dean Rusk; Dear Mr. Rusk : The good news

of your acceptance of the invitation to return to the SD r?

Bangkok some days ago.

     It is a pleasure to add my t- e*tiJ c di
                           ' ti congratulations to the mul-

titude you have received. Sincerely yours, FLS.          (a>
(4?#l   Call K. Bode's office;find him out t I want to discuss/publication
t&i\ CT,

of F&w% report (b) his success in selling the idea of doing a survey of the

salt supplies of all of Africa P outh    the Sahara.

DECEMBER 21st :

Call on Dr. K. Bode : (1) Get KB to change his attitude of compliance
        F&M UAL

regarding publication of -Bawl report.

     He agrees to take up my position. (2) KB says he has made recomnen-
   p CL                   on
dation w&-i& African Survey/salt supplies to the continent south of the

Sahara.            J.G
     (3)                       &.I**
           Says that J. Wi-er of the RF told.* that FLS is the best

person to undertake program'in Africa.

Lunch at CC with LLW and Sam Keeny. SK calls attention to

the need of It keeping SK Jr. and the man S ?  1 advised of the position of

malaria eradication in the world. ( Mr. and Mrs. Milton Siegel lunch with

Hr Hyde and Mrs. j

(SK tells story of new statesman report regarding UNRRA representative

in Sicily who was Ir said to have asked for a double room when making reserva-
       himself

tions for mxmiss and an Italian interpreter!  NS discovered too late that the

girl was IndulgLng in a literary effort and paid damages for liability to the

UNRRA representative.)

     With SK try to call on Mel Griffith but find that he left town this
             ,: ;i-(k
morning. (SK agrees fully -tha-t my analysis of the situation with the 7.1. ii-(\,,'/: I,

that nothing but good can come from' the publicity we are Proposing of the

Thailand failure.

December XXX 23rd:     Began day at JES office at NIH.

      -#.=x

      (1)   Stockard reports Sayeed Ahmed assistant Director of the

                                                                   J t
                                   /
Institute of Health,is delaying operations through inefficien/!: difficulty is
because this man has control of Cholera Research Funds.


(2)     Stockard has told Monsur he may not act independently of the

Deputy Director.

(3)   M?mur`continues his suit against the Governmentx pb return to his
position as professor)in which case he would return to his ffrrrf former-&

position.

(4)     Monsur not yet officially appointed to the Cholera Research Laboratory.

(5)   Will SRATO finance publicity of proceedings $holera conference if
                                                            ,        -5 *.
published in Dacca 9
            b&r- cc. vi4

Be FLS position WTCA:
--

(1)

Agreement covering this matter is between Goverlmnent of Pakistan

and ICA.     qi3iTih? Se-i'* bkll bLf*Y
(2)     NIHappoints VS*s only one year at a time.

(3)     Agreement terminates as   June 30, 1963,

FLS appointment is as VS in Geographic Pathology Section NHI.

SRATO Cholera Research Program (1) Mesearch.

                 (2) Training.

(3) Maintain study bases in Laboratory & Field.

Is Cholera endemic always in Thailand 1

*Base in DaccaU

Clinical    # Acute diarrhoeal diseases
         P
Laboratory #   of East Pakistan.
         P
Field Studies 1

Training center t   meeting of disease + experts.

    $4Oc)aOO.O0 fund used as reserve rather than routine operation fund!

Propose following:(a) Thailand SRATO CRIL.
        (b) SRATO Research Laboratory.

      (4   Epidemiology,

(b)  Bacteriology

(cj   Physiology & Biochemistry.

Pquipment Epidemiology ?

     Once &he laboratory is operating satisfactorily, activities under
the C R Project will be expanded to evaluate methods for control of cholera.

Cholera in Nepal ( Rathmandu ) :

Under date of July 6th, 1960, A.H. Abou Gareeb WHO wrote R. Pollitter t

(1)

Isolated true V. cholerae from case from suburbs of Kathmandu.

( Ogawa subtype j
         lB


`I
J

tinder date of July 29th : (2) Isolated 5 s. V.cholerae strains ( 3 Ugawa

and 2 rough j  some of these cases have been reported to the Singapore

office and should appear in the WHci records.

f
:'i

Abou Gareeb paper on cholera in Calcutta to Journal,Tropical Medicine and

Hygiene, May 196O:y 'I Cholera in Calcutta during the Season of Prevalence, 1959.

Tables from Nedpal 1959-60 suggest t Annual peak period,July-August

                    Low period,November to January

     Under date of Augus$3rd :  (3) Additional details indicating that
                               /;i'

cholera came to many parts of gMM Nepal in 1958 and,,59 and that XX isolation

camps were set up in a number of places.

To Do.
--

agreeable

Prepare quarterly reports for State/ICA and S.EATO ( Ih orm mutually
           P

to ICA & NIH.)

regarding

in member

NIH agrees to be guided by policy, instructions of HElLIllp State/IZA

coordination NIH work with .i~uS objectiwes in Si3ATU -

Includes coordination of contacts with Government institutions


countries.

Chief Public Health Advisor - ICA DACCA ?

December 25th, 1960 :   As has been the custom in recent years, Juliet and

I spent X$as Eve at the home of Ctswal&da Silva. ( The Brazilian custom is to

wait for midnight to open presents, there being a supper served just after
                             I i ! .: &'.

midrnight. Those present this year were the Bgges'and the Solon Camarges) and

the SilvasJand the Sopers.

S Camargo tells of the yellow fever outbreak of 1929 on the Ilha of

Paqueta and some years later riding the same barcas to and/from Paqueta with

Dr. Soper at 0545 and 1650 daily. ( This was summer of 1933 j
      A;*.

O.&'Silvah reminisee& about an experience he would never forget
                                  I

with me. He was called to come to I.;atiLfrom quixpda'and was met at the,_-
          7                        b!.&r. !

station in the evening by FLS and DBW; he did not know what he had done mEtk

     was wrong but expected to be fired for something.  To his surprise he was
  given no inkling of why he had'~&~~$ 'and u: u-ch?f &l ':.*.@.A C. ! ,,.L, t. j. ., 1.1 La; : $-

h-6 r&a   the wiser.  At 0100 one of the Brazilian doctors came to his room demanding to

     know what had happened; he could only say that nothing had happened. The next
                       L4.f

day he had gone with FLS and DBV to Ice for lunch , then had driven to some place

clear outside of the A. gambiae area to spend the night.  Only on return to ICO


the next day was OS given instructions to take over the ICU and Ja$mribe

posts and get them cleaned up.  ( He was given full responsibility for

results and was also given full authority to act.>

     I got out my journals from 1939 and learnt that this all happened

on July 25, 2b and 27, 1939 1 the decision was taken after looking into matters
to let Dr. MAR return to the USA and to remove Dgmasceno Costa and Luis Lessa

as incapable of following instructions, replacing them by da Silva.  My notes

show some of the reasons for the days being full of other discussions leaving

&jr:',-
'I
I

little time to tell US what was in store for him.

D&C&MB&R 28TH -   WASHIN(PTON D.C. I
                                 a-
     ,*f c ( !; ) ;',p' 'i
     Aad the State Department that Mr. Lewis Gluck Jr. and Mr. Howard
. .

    of the S&AT0 desk.

I have an opportunity to tell my ideas regarding the Cholera Research

Laboratory; my hope that it can become a truly multilateral effort; I gave

examples of INCAP and the Finlay Institute in +" ~~.~ `S .&A 4. .

4 takes over and says (1) That there can be no doubt but that more
         I:,,;

funds can be found fax,Cholera Research Laboratory from USA budgets during

the next five years.  (2j That I should be there at least two years

(3) That most important thing now is to get some good work started

(4) That in accordance with Article 3 of the Manila Treaty PH is a legiti-

mate field for SEATO.  (5j That so-called donor countries did not want to be

t*to SEATO projects on a definite annual budget basis but want to maintain

a voluntary attitude towards our project.  (6) Interprets my use of the term

real SEATU project to mean (a)- Multi-lateral or even bi-lateral with

SE;ATO label (7) Discusathe Indian Problem and indicates that arrangements
                                                          ".
                                              -' II I,

had been made for India to participate but that the m apparently came

on the basis of the meeting in Dacca being called a SRATCi Conference.
( LG takes the stand that SEATci cannot be ashamed of its existence and

should never apologise for its activities nor attempt to disguise them. >
                                                    t h* I& c /

(8j Indicates that SEATO is a convenient whipping *'or scape goat for certain

         rl
countrie f                4-a
    for political purposes but f)l## thii's&e countries have come to

rely on the existence of SRATO for their own protection; in other words the

BEAT0 position is stronger than it might appear to be. (9) LG points out that
                      1
                    k')

cholera today,that has the existing seedbeds of cholera,are a Pak/Ind. mono-
poly; the solution of this problem is so important to each of them that      2 CC


         k),- L.`d q 5          l,?+:
eventually some modest  oper 4= ndi will have to &aJworked out just as there

has been an agreement finally on the distribution of the waters of the d ,`Ofi
Indus river.  (10) That US has already discussed getting collaboration of other
      3.

countriels on the Gholera Research Laboratory and that the donor countries

want to hold for (11) At this point I take over and indicate that anything,

but especially health programs,have to be sold ; and that State Department can

only sell through lxa$i diplomatic channels but that FLS should be able to

talk to technical people in our country since it is thro-ugh the technical
                           4                          -3 -.      f
people that     can be &&+t~,-pily. "`TwL:L+r-~C ( (. .' , .
                       /

LG withdraws and leaves me with HJ for an hour. I point out that

(1) Cholera control should be eradication and that it is not an individual

country project but by its very nature must be 91:  in81;( 2) That Japan and

the'P1 sent representatives to the Daccy Con
        5l'h?ce r4 aG fA,gJJ 3
cholera since 1946 and the P?,spent his time in
WHU Sanitary Regulations refe:Jng to cholera. Even Egypt lost 2O$N.N lives to

cholera as recently as 1947 and should be interested in cholera eradication.

(3)      I reject the idea that the Cholera Research Laboratory should

be financed by so called donor countries; it is of importance to all of the

countries and is the type of thing which all should pay for.

(4)

I pointbd out that the Cholera Research Laboratory is the type of
           -&.

project which should not be put under,Government of Pakistan control because

(a) i&s work is of value to all countries and it must be kept accessible to
all and (b) by no stretch of the imagination will,, % %ernment of Pakistan be

ready to take over at the end of the 3-year period terminating June 3&h, 1963.

(5)      A basic situation of bilateral agreement must be changed if full

collaboration of other countries is to be had : taxation without representation

is tyranny.

(6)

PH is legitimate field for SEATU but Cholera problem is something

which needs international collaboration; no country can do this job alone;

I indicate that in the nature of things this project should have been a WHO
project but because of political considerations it could not(have) b<e+ a WHO

project at this time.
                           "L. -I rw
(7)     I also point out that,Government of Pakistan is not able to pay

adequate salaries and establish good working conditions for personnel of -72 c

at


Cholera Research Laboratory) experience already shows that if good people

are to be attracted and kept on the local staff, it is necessary to provide

them with something better then the Government can give.  This means that

arrangements with the Government of Pakistan should be changed so that all

operation of the laboratory is under Cholera Research Laboratory control,
&

with,Covernment of Pakistan contributing as do other countries on a cash

basis; just as is done in INCAP.

future

LC returns and we agree on a/fxx meeting with JJE and the three

of us to explore further the situation.

Call at the ICA and ask HS to send malaria documents to.,.&.

until the 15th of January.  Spent   whole   afternoon with JES and DP on
                                  #

agreement between NIH and Cholera Research Laboratory whereby some 411900

of PL-480 funds can be used by Choler8 Research Laboratory.
                 P
        Discussions with Mrs. m today over my relationship to NIH and
ICA;rfinally come to a head today; I point out I have an appointment from the
    #

NIH for 19,000 + 17%; that this appointment cannot be changed on the basis of

umxaxximaxx  conversations between offices3 that any change in appointment

should be proposed in writing by the NIH together with reasons for meking

it.  I indicate that since November 15th I h8Ve been trying to get a docu -

ment on which to make preparations to go to Dacca but have been unable to

get the statement of what I am entitled to.

I 8lSO point out that I am not applying to ICA for a position

nor am I taking on job at ICA; that NIH is not a participating agency in

an ICA Program but that ICA is a p8rticip8ting agency in a SEATO Project!
                                                     that

I also suggest that if ICA cannot pay 17% but must pay 25% lbiffi

calculations If be made on the 25% basis but that part of payment be
withheld under/R&
         -1  which limits amount which can be received by
                  L
any individual.             /


DlXHMBHR 29TH :
       A GL
   KB$alls regarding population item of ykG Report.
I agree to his 50, wk.
      KB says that the question of Liberia and its malaria service

has come up for discussion again and that AC.Curtis is still unwilling to

     of the picture as suggested by the Embassy and USCM 11) months
ago & that it is obvious that nothing has been done to im&ve the

basic situation there in the interval.

     fMail"comments on malaria Dots. 272/278- Malaria Inform 65>all
relating to Malaria in AfricaJto Weir, Bode and Campbell.
           9
      Talk with Gene Campbell (1) Advise C I am ready to accept KB's
editing of population paragraph>(2) mention 3 papers of WHO on Malaria

in Africa and emphasize their importance, (3) Suggest he call my remarks

  to attention of AC Curtis and           and Dan Johnson.
7       Get ll>OC mile check      MB car at 1000 in order to prepare
.                                         I
  for shipping at an early date.

DHCMMBNH 30TH :   F'RIDAY   - +yj54-kr'
     Ask H Hinderer for #&with someone to advise on purchase and
                   I(

shipping to overseas stations.
   V. Lameroux calls and says he is kending out all of the documents
                                               VL

regarding my case3including a 1956 post report on Daccal ( w seems surprised

when I tell him I have had some months now the April 1960 post Report on

Dacca.)

VL P says Ii_" k.--. ".. . -8 should see Leon B Poullade at state on the
                                        5

Pakistan Afghanistan desk at State>l82-2154.

      Talk with Pease who IL says that all is well but that m&j& my

reaction is awaited to the proposal of ICA regarding my salary.

      Pease says that the situation of NIH is the same in relation

to the ShATO Cholera Project as is the position of Indiana University with

regard to the Institute of Basic Medical Sciences in Karachi. I protest this

interpretation and insist that I am working for NIH to build a SEATO Project

for which SEATO had been given $400$00 by the &A.

      Letter is finally written by HH to JES regarding my appointment

declaring that ICA cannot approve my appointment at $19000.