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) ball 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.