EXTRACTS FROM PARARYRA STATION JOURNAL REGARDING SUSPECT YELLOW FEVER CASES IN (XAcARAti. 1927 September 19. Late in the afternoon I received a letter informing me of the presenoe of fatal oases of a disease with:: the symptoms - high fever, blaok vomit, jaundioe, hermorrhages - in a village oalled Jaoara& about five hours auto drive north of the Capital. After conferring with Dr. Guedes, I made arrangements to visit the plaae tomorrow. September 20. Tuesday. Left the Capital at 6:00 a.m., stopping at Sapd, kamanguape and Rio Tinto to enquire if any notioe of the disease had reaohed those places. The pharmacist in Mamnguape had heard of the oases of yellow fever (and heard of them by that name), but the doctor in Rio Tinto had heard nothing. Rio Tinto h,as a sus- aeptible foreign colony of about 84 people, and has nmtiained ita own anti-larval servioe sinoe the development of oases among the Gerrmns there last year. The servioe is copied exaotly after ours, even using copies of our forms. filled out were sick, In Jaoara$ I visited the families of the deoeased, v/ the epidemiologioal reports, visited three persons who verified the presence of abun n 3. -- seven houses I visited. %S After studying over the symptoms related, and the spacing of the oases in the various families, I made the clinical diagnosis of yellow fever in the seven cases (six fatal) that -ourred betweenmend Sstember 14. I reached the Capital about midnight. September 21. Wednesday. Sent a long telegram to Dr. Connor relating what I found and spent the rest of the day writing up the data. Had a long aonference vrith_Dr. Guedes, who $hou the information on $r. Conuor replied by wire that he thought, from the incomplete information that I had sent him by telegraph, that the oases were of nrrglignant influenza. I made plans to return in a oouple of days to observe further the cases which wBre ill when I visited the place first. There certainly were no indications point- ing to yellow fever among the three persons that I saw sick. -2- September 22. Thursday. Left Parahyba about noon, taking with me one of the guardas to nuke SOIJXI inspections while I talked with the officials. Imade a survey of Mananguape, an d a partial one of Sap6, arriving at Guarabira about 9 perno September 23, :.F%May. Talked with Dro Guedes, the Prefeito, end arranged with him to leave the guarda working in the city during the day. The do&a: was out of town, but the Prefeito had heard nothing of the cases in Jaoara6. Then I drove on to Jacarad, stopping at Duas Estradas, which is on the railroad and has the telegraph station nearest to Jacara6. Learned of a severe epidemio of dysentery in Duas Estradas in May, 1927, but nothing suspicious of yellow fever recently. In 1926 there were reported to have been some oases of yellow fever in Duas Es tradas. Arriving at Jacarad at 10 a.m., after driving two end a half hours over very bad roads. I found the three cases that had been sick on September 20, all mch improved, and c saw t ree more cii3SGen wgo,ken sick since my On the way-back to Guarabira I visited the village of Serra de Raiz, whioh is located on top of a high, isolated serra, about the most easternmost of the state. Nothing of much interest was learned there. In Guarabira the guarda had found about 50 per cent. of the houses with Aedes foci. Our anti-larval servioe was stopped in Guarabira in April, but the Perfeitura oontinued a service until July 31, after a fashion. I reported my findings to the Prefeito and to the doctor in uharge of the post of the P. R. The doctor had no-thing of importance to report0 September 25. Sunday. Capital. Dr. Connor drove up from Recife, arriving at thezhouse at 7 a.m. We disoussed the situation in Jacarat$ at length, and various other less important nrctters. The things of importance which we disoussed included: 1926 EPIDEIUC - Dr. Uuedes remr.rked that urior to the 192R \ - _~. _.~~..~_ - .-._.- ---- ------ ---- -- -_-- ---- , epidemit there appeared oases of vellow fever on a fazenda belonging to a relative of his, whioh was very isolated in the region of Caramati, pointing out the similarity of the occurrence now* --._--L) \ -30 September 27. Tuesday. Left Capital at 5 a.m. for-, third visit, in Mxaiking c-any with Dra Ulysses Runes, of the Saneamento RWa , the trip in place of Dr. Guedes, who finds himself unable to go on account of urgent matters in his office. All the patients that were sick on my previous visits are better to-day, but the two with slight Jaudice show that more markedly to-day. In these oases the diagnosis would certainly be influenza, if seen in any other oiroumstanoes. Therefore, I made the same diagnosis in these cases. Returned to Parahyba via P io Tinto, vhere.1 talked with the yesterday installed new Prefeito of the municipio of Mamanguape, also one of the superintendents of the Cia. Rio Tinto. I explained that Dr. Connor had reviewed all the data upon which I had based my diagnosis of yellow fever, and had come to the conclusion that the Jaracad cases were mow fem. Hence we were nOt, mrvice. I requested to be notified immediately of any 6u6piciou6 cases. The Treasury of the kltanioipio of Mananguape is empty, but the Cia. Rio Tinto is going to finance two guardas to work the city of Mamanguape. I offered to send the Guarda Chefe from Parahyba for a couple of days`to get them started. 886, l..._Capital with the ---- i&&a_ -fever, and-found nothing to ohange We reached the Capital ._ -.-- about 10 p.my September 28. Wednesday0 Had a short conference with Dr. Guedes Perreira, talking over Jaoarati situation more at length. Dr. Guedes still thinks that the cases were of vellow fever. __~__ %p%&G-expressed. There were no new developments nor new Visited Dr. Texiera Vasconsellos in search of mortality data for Parahyba Capital, requested by Dr. Connor. Wrote up in final form the various notes taken yesterday in Jacarad. October 10. Monday. Went to -alone via Mamnguape, returning via Rio Tinto, my fourt;h. I found all the people there recovered. In Rio Tinto I advised Mr. Rueger that it was probable that the cases in Jacarad ww fever. - Prom the subse ent history of the epidemic in.&carafi.- I am led to than e ';;I $-thin& XL nosis of the nature of the disease. now-that the cases were not vellow feverl but I am very much interested i-mining what they were. What killed the six pem alaria and plague seemwell ruled out., ThG%%&&gitis in Brazil, but none here in the North, and no mild cases have as yet been recognized. The chief purpose of my visit was to take blood from 'four-year old Francisco Fernandes for a Pfeiffer, to be d-n Bahia. ction,L- nd the result will not her. I got the blood. October 21. Friday. lvov. Nov. MOYO Received telegm from Bahia saying that the Pfeiffer-_ on Fracisco Fernandes of JacaraNegativez But, as I have pre- viouvoes not carry any weight with me. . 5. Saturday. Answering the accumulated correspondence of two weeks. Rothing noteworthy had oocurred in my absence. In the afternoon Dr. Guedes informed me that he had just been informed of-cases gf yellow fever in Jacarafi. detai.~%bmitted. Only very meagre 7. Monday. Dr. Connor and I went toa&,_a little over two hour6 drive from Guarabira. V-c~%%%se~ the sister of the child who had dw on Nwember 1, and took the history (see ficha No.PA-17). &mptonm lar to the other cases, but not, in our opinion, yellow Returned to Parahyba via Rio Tint: and Mananguape, advising the officials in Rio Tinto of our diagnO6is. In Parahyba we conferred with Dr. Guedes, Dr. Connor saying that in hi6 opinion the oases were not yellow fever, being possibly, pheumonia. In this case, through the poor good opportunity for a post-mortemwas lost. Jaoarati telegraphed me on October 30, but the at this office. Had it been> there is a good have been in Jacarafi when the child died, and scoured. local telegraph service, a The "leading citizen' of telegram was not received chance that a doctor would an autopsy would have been 12. Saturday. Guarda Chefe and I both worked on the follow up visits. Called on Dr. Guedee:, tax -the Jacarati situation with him. With the assistance of Dr. Ulysses &e~ranslated?%'f2cha (epidemiological report) regarding the last case in Jacarad, so that Dr. Guedes could send a copy to Rio. Dr. Guedes is very much worked up wer the situation in Jacarad, being positive 3 I 6at the cases have -yellow fever. N------c-- NW, 12. Saturday. (Continued) In the afternoon 1 called upon Pr~ssuna, to tell him of my trip. In the course ofaversation the matter of Jacarad came up. The president remarked that he was quite satisfied Vses were not yellow fever , upon epidemiological grounds. 4nd he remarked that Dr. Guedes was unduly exoited about the matter - and wa6 inclined to get too excited under similar erasrgencies. The president fmpresses x16 as a very intelligent, alert and energetic person, of a type all too rare in Brazil.