T FLS 1930. J 2. Davis wire8 that Hair liver Vioosa hlagoas negatives this ca8e wa8 autopsied by Almeida about June 18th~ wab young ohild without m oal history but living in known heavy yf foous. Almeida notified. Wileon wire8 regarding Barr08 Barreto account; reply that account 8hould be charged through the laboratory to be paid entirely by the RF. vi8it ten house8 in Zone 51 with the guarda and Crawford3 one steg larval foc~a found in barrel; nobody complaining of carapanas now but several state that 8014~ time back there were many mO8qUitOe8. Dirrouss with Dr. Albino Cordeiro the possibilitv of autousie8 in the interioahe skates that the problem will be very difficult to solve and that he personally believe8 nothing w be aocomplished exaept through dootors of the health aerviaes or through doctors who also happen to be intendentee of the oounties where they live3 nothing is to be expected of the tabelliaes(registrar8) a8 he ha8 never even been able to 8ecure from them reports on the total number of death8 occurring in their diutrictsl Then too the people of the interior are very ignorant and are very superstitious regarding the bodies of their dead; all in all, it is palin that he advise8 against the making of the a#tempt to secure the disease exists that the disease ha8 aither hung arouM in Belem since July of 19a9 or else ha8 been subject to exportation end importation since that time. (Of. course both hypOte8e8 may be true at the lame time.) In any case for the future of the control work it is important that we know how much of the disease exists in the interior of the state. Dr. Valle gets the idea immediately and suggests that we oall on the chief of the state police in'his name and ask for cooperation end suggestions as to how`suoh'a service can best be organized in the interior. During this conference with the president, the question of. calhas,is ventilated quite thoroughly; Ev reports that the measure is being forced through a8 'a municipal one which is where it should be according to the division of pre- rogatives3 he insists that the measure should have been presented to the Mun&&ipal Council yesterday; the Secretary of state sqrs thr.t i-!; L.c '-0 be i'rol~ght up for vote today. Call on the ohief of the state police who is also judge rn Braganca; he from the seat of registry end often '-1 have occurred several days before being regiateredi this most logical solution of the problem then which would appear tb strike the source of 8upply is not to be recommended. The tabelldio also is not directly subordinate to the administrative arm of government and would have to be handled through the judiciary. 2nd. Through the 8ergeants of the state polioe who are to be found in every distrirthese men,however, have no direct oon- nection with the mechanism of burial except in special criminal cases and are in many oases entirely illiterate hav&ng been chosen only on the b-is of their ability to dominate their personnel and their districts. The only advantage in using them would be that they are ubiquitous and under direct oontrol of the uhief who is willing to help us inaevery way poaaible. 3rd. Thro the tend- entes or loosl oounty administrators; the intendente in x p aoe Yi--Yi!Si%p+!!&zea- by the govenuF a8 Ene looti representative.of the state government and is very sensitfve to the suggestions made by the state. 1 FLS 1930 J 2. continued. + The intendente has under hi8 direct aontrol the adminis- trators of the cemeteries who are generally very poorly paid and should be willing to take a real interest in getting liver fragnents$or a 8mall premium per fragment. The ohief recommend8 that we first try for livkrs through the intendentes. I accept the suggestion but insist that the attempt be limited to one or at the most two oounties until the routine 0811 be worked out. Dr. Albino indicate8 Vigia whioh lie8 between Belem and the Atlantiu on the rieht bank of the Ama8on a8 a good place to start a8 it ia aooeaaible and is prgbably the most or-tan-t point of departure for the amall boat trade covering l&e coast north 0 e Amaron. Actual detail8 Of Organieation are le f%Tz--- ?'uture determinati on. r. Crawford will probably go to Vigia to arrange detail8 with the intendente. - Mote8 regarding dis&xssion of looal problem with Dr. Crawford during the last four*. days; Medical Vigilance. PJC has been using one of hi8 doctors in the after noon8 to`ahe& up on the alinioal histories of reported death8 whioh from their diagnO8e8 might be thought to have beendue to yellow fever. I suggest that this iervioe be disaontinued a8 8oon as aonvenient irltiout letting the local authorities and our own personnel know that the diaeontinuanoe wa8 suggested by me. our programme. When pressure 18 brought to - bear attent eophilo Torres' report on the Fabrioa das: Chitas epidemic in 1907-08, the last epidemio in Cru6'8 time in Rio. Torree inc sists that the direction of spread of the diseare wa8 influenoed by the direction of the prevailing wind8 oar-g infected mosquitoes driven from infeoted hOUSe by fumigation always in the same direction. Similar relaiA&mhip ha8 been claimed for oases occurring in upper and lower cities in Bahia. lbcidents to aployees. Workers injured in the line of duty may.be sent to the Assistenaia Publioa and treatment paid by yellow fever service. Prefer that Dr. Crawford take no part in treatments. Potifioation of Yellow Fever. The yellow fever service should always notify looaf. health authorities of both the state and the federation; newspaper notification8 should come from other souroes. ( The two accidental oonfirmationa of May were notified by PJC to Dr. Albino; the governnr of the state suggested to Albino that the oases be not reported.) Should take into due consideration the diagnoses made by Dr. AbenAthar but should always submit specimens to Davis for oonfirmation. Classifioation of Guardas. Suggest relatively small difference be- ween salaries of guardas of different olassesi probably 2200, 240$ and 250$ would be reasonable basi8) focus found.behind guarda by GC to be counted against guarda for classifioation only after verification by doator or guarda chefs geral of the service. Focus b&&vi guarda 'GO be 0)~1-?--~-? ?iLy if found within 36 hour8 of the time of hi8 visit. Classifioation of Guarda Chefes. I fail to approve this idea. GC is in responsible position at higher salary and is supposed to know his job. Suggest more rigorous checks on s defects in theer service; classify but fire for in Increases in personnel. Should be made only after due authorization. All American direotor8 will be constantly informed of my whereabouts by telegram. Authorization at present time is made Bar appointment of guarda ohefe to direct and check work of the gytter squads; for increase of office personnel to permit of all strictly routine work being done by subordinates, to make block indices available on foliowing day. Also special clerk may be hired to keep file of FLS 1930. July 2. continued. legal notives and fines, Distribution of Fish and Sealing of Water Boxes. As both Uuench and Crawford believe that the institution of these r'easures which are expensive would not greatly better the $eoal situation, it is suggested that eduaational means be attempted to get deposits fished and water boxes sealed. Fish will not be furnished here but are so readily available on all sides that no one should have diffioulty getting them, In the meantime, first oiling and breaking and then fining is to be folbowed out in repeating foci. Station Journal. Only one station journal is to be prepared in Belem. The doctors working under Crawford should submit to him whatever details of their work he desires; important points in their reports or regarding their work may be included in the station journal. The station journal should be limited to relevant information; oorrespondence and telegrams need not be copied except in so far as it is desireable to insert verbatim instructions or vital information. It should be remembered that the station journal is a Station Journal and is neither a personal diary nor a narrative report to the central office; any matter requiring action or discussion by the central office may be mentioned in the station journal incidentally but should also be called specifically to the attent- ion of the director *special letter oovering the point. The station journal is- intended specifically a& a running hi8tOI-y of the Sme for the future Orientation of the director on all important points for which he would atherwise be forced to depend on memory &d for the orientation of possible future directors who have no first hand knowledge of the situation. Sick Leave. Employees reporting sick are to be investigated by the GCG or one of the medicos. Raoh case should be judged on its merits and pay continued in judgement of local director up to maximum of two weeks. Mother Foci and Breeding Roof Gutter Oquads. When daily information on steg indices by blocks is avallable, special. guardas may be detailed to work dirty blocks to discover pupal foci. A special ladder gang is to be detailed to -the ex- e&nation after fifteen days of all roof gutters found breeding on previous round. Stamping of receipts for paymenta. Up to the present time the business house8 of Rara have refused W sign dupxcate and other copies of receipts without affixing revenue stamps to such copies. In the past two copies with stamps have been submitted, one for the government and the other for the RF account8. The other copies that must be filed in various places are nothing more than the account8 as presented and carry no notation to show when, if, and to whom paid. suggest that a rubber stamp be prepared oarrying the declaration to be signed by the house that a receipt for payment was signed on eugh and such a day. Numbering blocks. Suggested that blocks be numbered on the four o&ers with arrows indicrating Ehe itinerary of the guarda and the number of the zone. 3 UL Y ,3* 70 FFc - .mrl~ t-9 +A &)/Z. FLS 1930. July 3rd. After discussion of local situation with PJC, suthorisnd the . following ingreases_parsennel. office staff, 2 if nt3cessapJ; gutter gangs, one guarda chefe, one guarda, 2 serventes, 'these squads of 5 men each, now working on vacant lots. This number can probably be )eduoed, after the first time over; one man now on ditches and G men in districts '7 and 8 is one lesseach serventes working with the guarda)) mother foci squad, one guarda. July 4th. Arranged with Dr.Albino for our men to get the keys of empty houses at 4 p.m. one day returning same at 2 p.m. following day. PJC and T visit vacant lot squads and find excess of zeal in cutting trees and slack work in collection of water containers. Sail at midnight on Itapk for Rio. July 5th. On board ItapB. July 6th. Spent several hours in Sbo Lm Dr. CM and guarda chefe report everything in good shape with recent emphasis on preven- tion of gutter breeding. I explain to C!&! result of routine autopsies in Eelem. He promises to secure in the near future 30 or 40 autopsies frog _S~i.o_LuJz. Fe is not so hnoefill about aut ve oosies from the interior. Ila conference with Dr.-Pires &all Director of Prophylaxia Rural for the State of Piauhy, with heaauarters in Therezina. Dr.Leal is a brother of the Governor of the state of Piauhy e.nd has been bringing pressure to bear during the past year to secure a yellow fever service for his State. I have promised him such a servioe just as soon as he secure a positive autootv yellow fever. Dr.Leal has i,"ly 7th. On board Itap6. not heard of any suspect cases in his State. July n Lunched Fith Dr.Uchoa.,. FTe reports local situation un- changed. SU is anxious to be re&ed of the responsibility of the yello-.~ fever service. I suggest Doyle will b: able to take' over about August iOth to 15tk. July 9th. On board Itape. v for able and shaa reduce July 10th. Recife. Dr.Rickard demonstrates first..work% model of ins&w rem0 * rr liver section. This modeXapoears pratic the dangedction-of persons securing tissues and should make the onera more acceptable to the public. ERR reports satisfaction with new forms but suggests waiting longer before general adoption. Wire Dr. Rocha requesting s tion tate- ment of future plans. July 11th. On board Itap July 12th. Bahia, Saw Dr.Fernando Luz. L!y im ham be sent to Aracajd not later than July 15th. Secure list from laboratory of people in Mag& from whom further blood specimens are to be procured. Davis and Shannon returned They believe Ilheos infected. (1~ _: ;L i&y,,,,.,\ d Itapk. July 14th. On board Itapk. Arrived Rio 7 p.m. July 15th. Day at office largely routine. Bahia. Probably influenza. DB?Y reports suspect cases in Spaniard, (Later July 22nd DBY reports lung consoli- dation), probable diagnosis influenza pneumonia. Conference with CF. Quite frank statement to CF of difficulties of situation in North. -~&g Repo_rted opinion regard- CF very anxious for immediate steps. I reply l,ilson has been authorised '-%r te control me"sures there as soon as laboratory report is available, but that I see no reason for precipitaeed extension as far as Rio de Janeiro is concerned, because it would appear that the yellow fever virus has been present FLS 1930 in Ilheos at least since January, -h ..~_ furthermore this is the least favourable L___- I season df the y&&$-for development of yellow fever in Rio. ~'aldsmar Rocha cables resignation from yellow fever service 4 July 16th. Registered garage transfer with the police. Dr. k- It"-// aranhos comes to office and reports activities in New York. July 17th. To Oswald0 Cruz Institute to discuss situation with &-a&o. Spent the evening l:rith Araggo and R-Lima discussing various phases of yellow fever work. Secure promises of white mice from both Oswaldo Cruz and The Biological Institute in Sbo Paula. DB?'Y cables sugkesting Dr.'Lima Netto be relieved from service in Bahia: Release aoproved with payment of one months' salary. July 18th. Presented report of yellow fever service for May to CF. Called on< S.Lima and discussed local situation with him. Call Dr.Ferreira.~~ti.l:.~~~ Pinto regarding samples from Mage but learn his sisters' illness will prevent ,, 'his working in the near future. missing both boat and train. Cunningham finally left for, Aracaj6 today after July 19th. Anderson of Standard Oil offers services of oatent attornev for $ making out necessary papers on&sue i invented by Rickard. Doyle ordered to proceed to Bahia and thence to Recife immediately. Conferenae with CF who approves Dr.Bodrigues porta to Recife, Dr.Jo&Cesar Oliveira, Fortaleza. Dr.Sraulio Furtado Luz, Rio. These men will be hired im$'ediately as well as Dr. Virgilio Oliveira and Dr.Couto h@er in Bahia recommended&y CF. Ratify CF that I shall move my headquarters to July 20th. Sunday. Pernambuoo in the near future. July 21st. Receive at Treasury Rs.17:323$978, various accounts. ?Yilson reports 133.~0 en route to Rio on Prudenta de ?&n-&es. Davis reports virus from 6th mouse passage killed monkey y.f. 'July 22nd. Lunched with Decio Pnrreiras, Director of yellow fever service, State of RIO de Janeiro. ing our results in Magk: Authorised followirq; statement in his report regard- "Mage studies indicate more immunity than yellow fever". Our results are not ready for publication and probably will not be for some time yet. DP calls attention to fact that yellow fever in 1928 and 1929 was limited mostly to zone flictheroy, Rio, Rezende, whereas 1931, yellow fever has been found in !:Iage and Cantagallo to Campos zone. Admits yellow fever in following places: Between April 1st and June 3Oth, 1930 - $&.&e(Mage), Portella, Tapera (Campos), Itoaeara and Cantagalla.rn addition he states confidentially that tissues from a positive case 'T7FGGGity of Campus, arrived in ?Jicthe:roy today. DP and I discuss f routine autopsies. I sumhe publish DP refuses to publish on own authority. Discuss the difficulties existing between Health service in the State of Rio and National Department of Health. However, he promises to furnish me with w details of his service and results to be included in a note in "0 Saneamento". bP states Dr.A.Luz is now working in k&age. rrornises full cooperation in securing blood specimens from Mag6. DP reports that Cantagallo was diagnosed from analysis of death certificates and entire town had been fumigated and entire larval service organised two days before first clinically suspect case was reported by local July 22nd. (continued). Call on LirZdwurds, i:.anag;er of the 14yrba of Brazil, and discuss method of securing rebates on passages. lL;r.idwards promises to send recognition cards for our use. uie discuss quite frankly the possible rela- tionship of air passenger service to the spread of yellow fever and I suggest that the air Companies should be very much interested in the control of the disease as quarantine measures instituted among air passengers would most certainly kill the air passenger bushess. Incidentally I suggested that the cost of passages for men in our service should be further reduced. July 23rd. At my request Z)r.Henrique isagi%o came to the office for a discussion of a special yellow fever cor;mission suggested by I)r.Connor to study the yellow fever situation in the North and make recommendations. This co~aission was to have been appointed by Ur.b'raga - at I)r.Connorfs suggestion and &ILL reports it __z ._-. -- "c.----- _... would probably have been composed of Dr.k*aldemiro de-0.liveira of SAo Yaulo,Dr.Thomaz -__I hives and hir%ek<*with pr%%ly%%-&~er as yet undetermined members. H&and I discus'&-qwly the possible utility of such a comission. HA sees no pos- sibitily of the report of such a commission influencing the betterment of water supply systems in the North. Under present economic conditions the Federal Govern- ment will be unable to assist in bettering local water supplies even -if such a measure were possible politically. I point out to HA that we actually have at present four m oming in tiat maA be considered possib . nentmlc areas* namely the D.fi1.S.P. in the E'ederal LEstriot, the Prophylaxis kural in the State of Rio de Janeiro, the Prophylaxia Plural in the State of &inas Geraes and the Yellow Fever Service of the Hockefeller Foundation in lu orth Brazil. Furthermore it would appear that the State of Esyirito Santa, lying bet%een the dtates of Bahia and Hio de Janeiro, is without any regularly organised Service. mible benefit I can see for such a commission might come from the Colmissionss development of a programme for rettlly united control of thsellow fever problem. In order to - secure such a result however, 1 in the existing political conditions, the Commission ; - would have to be endowed with more authority than could be possible if organised I ; and appointed by T)r .Frsga. Nothing less than a congressional or presidential i Commission could give the desired results. The appointment of a cormnission as was > suggested would probably lead to a report full of recormnendations regarding methods ; of control which might very easily serve as a basis for unnecessary criticism of ; existing services. I tell l2r.H.L that I shall discuss the Commission frankly with ! Dr.Pr@ga in case L)r.Fraga brings up the subject but that otherwise I shall not push :' the matter. _j; ILli believes E'raga will take an interest in case he continues with the Health service under the new Government in I\iovember, mainly in yellow fever and an Institute of hygiene to be established in Hio de Janeiro. HA hopes to work with mice in the laboratory in Hio; has no desire to do epidemiological surveys in North Brazil. Hickard reports suspect autopsy Correntes, Pernambuco. Doyle left W &racaj< i2nd. July. Cunningham's request for special guarda for intbiation service, referred to builson. July 24th. Cunningham reports guarda attacked with resulting laceration of scalg, while on duty. I cable Governor iicianoel Dantas requesting necessary support. Doyle sails for Pernambuco. Discussion of' yellow fever epidemiology with Drs.Lessaand Jansen. I point out importance Of recent findings in State of Kio de Janeiro and North Brazil and FIS 1939. stress imoortarice of routine liver examinations. b;ord received of death of Dr.Theodore F2Kap-e from yellow fever, at Lagos with onset 11 ~$?'_t_er_inoculat~une sera. ? _ Me__* ._ -. D New York office advised regarding Ehtdget needs for 1930. July 25th. Biao arrived in Hi.0 from field trip investigating Sao Pranscisco River zone,State of Bahia. He collected bloods for the laboratory from several points; found nothing suspicious in zone and secured no histories of suspicious cases with the exception of two cases in Barra occurring in 1925 or 1926. BiEio and I visit Usu;aldo Cruz Institute and arrange for necessary sterile supplies for collection of' bloods in ;Eiag& and also arrange for more white mice to be shipped to Bahia laboratory. Called on Eraga and bifio reports on Silo Francisco trip. CF promises to arrange for exhibition of the new yell@:r fever film prepared under the auspices of the Health Department for m$r benefit. CF agrees to come to our office on Tuesday,July 29th for a more complete discussion of the yellow fever problem than is possible in his office. Learn from confidential sources of suspect case from >1ict,heroy in Hospital (case visited July 26th; somaihat jaundiced w-ith positive diagnosis malaria. aother suspect case died yesterday; autopsy diagnosis Pyelonephritis,) Health The Governor of sergipe ctn;les aggressor fined 500;Y;OOO by State [~[h~y service and faces further prosecution criminal courts. Fraga on learning of death of Lr.Hayne in drica, suggests Foundakion use brazilian personnel from endemic areas. July 26tg Ur!k!rz' 7 . . , professor of hygiene, iiiedical School in hictheroy spends morning at office Bi.&o and I secure material for hag; from Institute. July 27th. Sunday. Biiio and I spend day at Ma&; secure 15 bloods for repeat examination by laboratory. BiEo will continue this v;ork alone after today. FL3 1930. July 28th. The politic4 situation is somewhat comp!.icnted by the v (July 26th) of Dr.J~?-@3oa, the President of the State of Parahyba and the v-ice-President of t=position in the recent national election of March first. Redife where the assasination occurred and Parahyba are both reported to be in a turmoil. July 29th. Attended funeral of the sister of Dr.Ferreira Pinto. Dr.&-nest0 Para.n.hos discusses Mayo fellowships. The reoent suspeot case designated for mnt of better information - es "Correntes X" came to the notice of the Public Eealth authorities through a police request for autopsy. Death had been so sudden and unexpected that ed. (this case positive NCD). Correntes is in Pernambuco epidemic zone. As arranged last week Dr.Praga came to the office today for a discussion of the yellow fever programme in North Brazil. I outlined for him the programme approv- ed by Dr.iifamer; I stressed particularly the value and need of Feneralised autopsies throughout the yellow fever area. CF agreed to issue special decree or authorisation to 130 drawn up by us to facilitate workinp with local authorities in the North if difficulties should arise regarding autopsies. CF requests another copy of annual report for 1929 alleging that previous copy submitted by Dr.Connor has disappeared from his files. I notify Dr.Fraga definitely that I expect to transfer my headquarters to Recife. Brought up question ofCaounFfiaio~~~~+b~.,Dr&annor for discussion which was very brief. CF agrees with me that there is no occasion for such a Commission at the present time. Rickard advises of delay in Doyle's transfer to rarahyba due to unsettled political situation. July 30th. Drawings of new instrument due to arrive today, were not received. W-red Dr.Cunningham that only financial matters %o be taken up directly with this office; everything else to be referred to Dr.Mlson in Bahia. Circular cable sent advising all posts of my proposed trip to Recife August 4th. Box of 70 white mice received today from Rocha Lima in SBo Paul0 which I shall take to Bahia for Davis. July 31st. Lunched with Dr.Thompson Cotta, Mrector of the Assistencia Hospitalar. Lunch given in honour of Dr. C.C.Burlingar;e of the New York Medical Center, who has been to Uruguay at the irrritation of the Uruguayan Government to advise regard- ing their medical center. Dr.Burlingame was particularly interested in what has been done in Brazil in the development of the nursing profession. SU advises Dr.Jo#o Cesar sailing for Recife August 4th. from Fortaleza. F':ired Dr.Rocha suggesting he await me in Recife. Suspect case reported from Par6; J.Kislanov, recovered. No alhuminuria. August 1st. Mr.Robinson, of the Brazilian Land and Cattle Company, called and reported much ma1 de oadeiras at Miranda. Requested further information regarding the use of Tryparsarnide. tnformation received Parah ba Y service has been unavoidably suspended be- cause of excitment due to recent assasination of Pessoa. Dr.Rickard cables liver instrument gave good results on recent cadaver, Poor results on 18 hour cadaver. Decio Parreiras sent me dra;lring of liver punch dated . . - July 12th marked Wclichd para 0 Saneamento". AA advises hot-iever, that such punch has never been constructed; that today he overheard orders beinr p,iven for construction by Lutz,Ferrando of liver punch along lines of Rickard model described bp me to Dr. Decio - ^- - Qn July Z%nd. Rickar_d'.s drawing not yet rece-ived. I-- -_ -_- . _. Am wiri,ng .todaar- for duplicates. jayments will surely be made T:ithin next 15 days. I refuse,how- _/- -- - AS. reports F ever, to leave signed check to facilitate the pay-men?; during rn% absenbe. AA reports he has been made direotor of the yellow fever service for the first district in Nictheroy rr!it;hout increase of salary. PLS 1930. August 2. Letter written to DP asking for working model of his liver punch since he submitted with themnps no notes regarding results obtained with Drive to Institute to secure another seventy,mrather fifty, mice to be taken to Davis in Bahia. This makes a total of 120 available including those rec.-d frcsn Rooha Lima this week. Arag&o transmits Chagas' request for used monkeys for other laboratory experiments. August 3. Sunday. All day at the office. Translation of WAS letter for Fraga end quarterly yellow fever report. August 4th. Telegram 'from ERR anndunces drawings are to arrive'on Arlansat Arlenza arrives at I em and by dint of 'special influenoe' the drawings are secured frcm the postofeioe at 3pm; hurried consultation with Rumpstone and Anderson and lawyer of Standard Oil* in name of Dr. J. Tomaz Alves, since I Meet Captain Yancey of the USA to Italy flight. ConsuWation with Shobinger regarding gutter construction on the large -new shops of the Light company in Rio. Estimates -proposed alterations will cost about one thousand dollars. BiZie reports securing only forty more bloods during the week; however, this may not be so bad since the group to be bled in Mae;6 is now limited whereas last year we were bleeding everyone. Gave him additional list of subjects to be bled and arranged for more sterile material from Manguinhos. Woman physician from school hygiene section of S&o Paul0 requests RF fellowship; would be satisfied if RF would pay passage money as present salary could be continued from Eellth Service. Promise to discuss herecase with Dr. W. de Oliveira although she knows the fellowship service is already showing a deficit. PanAmerican Airways Company's representative calls .a11 worked up over a cable received from Miami ordering to-day's plane leaving Rio tomorrow not to touch in Par& beoause of yellow fever epidemic there; discuss c-uito frankly the actual situation in Par& and give him statement that no cases of yf have been con- firmed for Par& since the 21st of June; wire PJC to give similar statement on arrival of plane in Be&. I take advantage of the moment to impress upon this representative the .importance of yellow fever control to the air transportation ca companies who have only one product to sell, viz., speed; five or six day quaran- tines would of course spoil everything for them. Suggest that PanAmerican planes be available for my travel even though they are not yet carryin Before embarking on the Itapag6 (Capitan Parry $ pasCemgers. at 4 PM, ccmplete translation of WAS letter and autonsv decree for signature of Fraga. Dr. Bra&o Lue arrfved Bahia July 31st. ;5;;. Ay;; On board Itapag6. P Meet Dr. Guimarags, State Superintendent of Public Instruction State of Bahia. Speaks English knows the US and should be of assistance in giving information regarding the interior of the state of Bahia. 7t@ August Met by Wilson, Davis and Shannon. Call on Frobisher who is having his third or fourth attack of'yellow fever'; Davis refuses to take these attacks seriously anymore. Onset Sunday August 3rd, with very definite headache and body ache$ some fever and possibly some disparity between temperature and pulse; slight albuminuria on third day and slight icteric tinge to solera today. Feels quite weak and listless. . Delivered to NCD following material; 70 mice from SBo Paulo, 50 mice from Rio, one box of sera 3rom the Scan Francisco trip of Bide with included list end one box of sera from Mag& with list. NCD reports that the previous batch of mice brought from the Institute were infected with mouse typhoid and that this mouse typhoid is capable of simulating the pathological p-icture of yellow fever in mice including black vomit; in attempts to filter out the offending organijsm from preparations of mouse brains it appears that the virus has been lost after the twelfth passage; NCD suggests that time can be saved secure mouse strains from NY; following wire sent," ROCKFOUND RIO SEND NIGHT LETTER NH YORK QUOTE SEND DRIED INFECTED MOUSE BRAINS SOPFZ@ NCD reports Description of Male Genitalia of A. minor sent for tiepartamsnto S.i?~blica. "ITOTITE DO BRAZIL A , `.. j . . Recentes experiencias em dir'fererztes lo,:*alidades do norte e `.I sul do Brazil tgrn demonstrado a necessidade de autopsias systematicas nas 3 I regiges endemicas ou suspeitadas endemicas de febre amarella, corn o proposito / / de 2escobrj.r a presenga de cases dissimulados desta doenr,a. ,.)' , Rconselho calorosamente 6s autorj.dades saqitarias, aos clini- cos e a todos que se interessam qela extincqgo da febre amarella no Erasil, que promovam e *facilitem autopsias em cada7eres de pessoas que terham falle- --- --.-..NBb- --\_ _ \ -. -.. . . cido corn zenos de riez dias de doenpa se2 assistencia med4?a, e corn symptoF:as I. -.. .--'-- -.. febris. g vma medlda de ma-rork today Monday stop URGENTLY NEED MORE TRANSPORTATION FACILITIES stop Wilson. (This is cand- idate recommended by Dr. Fraga. made here through Mr. Tate of Gen. To meet need for more transportation purchase was Motors of new Chevrolet touring car delivered in Bahia at 4:3O#OOC or $462.00 at preseat rate of exchange, Car 1929 model.) the I wired Wilson and Cunningham that FINANCIAL REPORTS of Aracaju should in future be forwarded to Wilson in Bahia rather than to Rio direct. Wired Alves not to discontinue patent process as yet. Personal telegram from Doyle's father forwarded to Fortaleza. Advised Cunningham of arrival of American foresters in Par&. Wired Cmmfngltamega~ding need of more automobile transportation for Par&; . --- at aDove price I feel we should get sufficient dars for the immediate future. Wa FFR proposing autopsy program on large scale. Gouveia who shows telegram from IPIRIlI[BIPBEL@QE~ot-baESTACIO COIhlBRA intervention with Dr. Sonper to secure nomination of Dr. Yellow Fever Service in Par&. ,' i ' , / Aedee Mosquitoes 63' Sgo Salvador, Bahia May - 1930. 1. Aedes 2. Aedes 30 Aede8 4. 6* 6. 7. 8. 9. Aedes Aedes Aedee Aedee Aedes Aedes Transmit8 Yellow Fever (Stego~@a) aegypti (Linnaeus) 588 (OohlerOtatU8) scapularis (Rondani) Yes, (Obhlerotatua) eerratus (Theobald) (Finlaya) osnaldi (Gordon & Evans) (Taeniorhynchus ) taeniorhynahua (Wiedemmn) (OChlerotatU8) hastatus (Dyar) (Howardina) fulvithorax (Lutr) (Oohlerotatus) filvus (Plliedemann) (Taeniorhynchue) fluviatilis (Lutz) Yea Feeding expta. imon- clueive. f Injection of emulsified mosqdPitoe8 ye8 positive. Yes (In emau $ of 8Xpt8$ No (Adults refused to feed on monkey8 ) No ( Negative to date, but number8 inPldequate 1 NO No experiments Yea.. Readily infeot. 10. Aedes (Oohlerotatus) crinifer (Theobald) ? No This species ie known to occur around Rio and further south, but ha8 not been taken here. + e fulvw was found by us in Bomfim but has not been taken in the neighborhood of the capital. N. C. D. FLS 1930. August 12th. JTA wires that Dr. Ferreira Pinto wishes to work with the yf service beginning September. As FP has been with the Malaria Service of the Division in the State of R&o for a good many years, I shall do everything possible to take him on ; probably good man to aid in epidemiological investigations. It was from Mag6 last year. he who assisted me in-collecting bloods August 13th. Left Recife at 8:30 A%_ with one week tour of the States following itinerary; ERR in Ehevrolet touring car for a of Alagoas and Pernambuco with the 1st day, Cabo, Excada, Frexeiras, Ribeiriio, Gamelleira, Joaquim Nabuco, Palmares, Ribeirgo. Pedras, Barra Santo 2n;o;;sz ;g:;Tira, CucaG,Barreiros, Sgo Jos6, Marogogy, 3rd da , e spent in Ma'cei'o. a , Sgo Miguel, Penedo, S&o Miguel. ay, Anadia, Tsnque Darca, Nar Vermelho, Pindcba, Vigosa. m, Quebrangulo, Palmeira dos Indios, Bom Conselho,Garanhuns. '7th day, ,780 Caetano, CaruarG, Bexerros, Gravatk, Victcria, Morenos, Recife. - The speedometer showed a total kilometragem for the trip of 1422; notes were taken during the trip of distances from one point to the next but n.re not included here as they are of little value in planning tine taken; suffice it to say that each day's trip carried out according to Tbove schedule gave each or us atl~ $hr work tie v'ml:k~i' for the day c?r' viny; only one half the distanceA Drivers were changed every thirty kilometers during most of the trip and the roads ::lerc such that sel- : dcmedid the man driving forget to look at the speedometer in time to make -%o shi&t. I However, with the exception of the zone fn the State of Alagoas bettioen Acadia and Quebrangulo which is really quite a hilly almost mountainous district, the situation in regard to road improveaents can be considered hopeful. Dgubtless during the peak \ of the dry season, most of the roads traversed will be in very Sood shape. ! Palmares service consisting of three guardas&& one guarda chefe, who also acts 'I as guarda chefe for the services in Sbo Benedict0 and Quipapg, was inspected by Dr. i Rickard only minor defects being found. -L Ribeiriiio. Slept hero under mosquito nets ; many culex and ple%y of stegs about in spite of part time municipal service. August 14th. Met at Batira Santo Antonio by Dr. Almeida who returned to Maceio with us. Reports there can be no doubt of the diagno$$s of yf in Pindoba; August 15th. Assumption Day and a full holiday for everybody except the yf service in Maceib. Announced to Dr. Almeida that from now on he will report directly to ERR and that $11 report2 of al- to go to Recife; call on Dr. Meneschal, director of the State and Fe&era1 Health Services here and present ERR as our sectional director. Discuss possibilities and need for auto!lsieq ERR goes over organization and local situation with MA; no changes to be made at'oresent . time . f Dr. %choa wires that m has_- &+ 0~ r..&hw&L9g,b pf ,22i2.3&~--Qr.?e~~~~~ t p e DBW notified prioe of Chevrolet includes bumpers and &ock absorbers. .I .s----* Authorize Machado to purchase furniture for my office Recife. PJC requests another car for Par&; Tate of GM authorized to ship from Recife one 1929 Chevrolet touring car at 4:509$ plus cost of transportation. PJC wires monkey with blood from Kislanov showed nothing in two weeks. NCD; Liver Marie Andrade Natal Negative. Bloods Raymundo Passos, Joaquim Passos, Andrade of Par& all failed to protect rhesas. Francisca Passos and Domingos DBW sent copy of yf contract in response to urgent request; should catch Condor plane tomorrow. I cannot imagine why he needs the contract. Residence, Edgar Farias, Travessa de Curro 36 Harold Chandler, Trav. Bonj. Constant 96 Par&. FLS 1930. Auvst 16th. DBW returned to Bahia to-day after two days in Aracajc. ERR MA and I visit service in Penedo, the principal port at the mouth of the Sgo Francisco River. Call on Dr. Jocelyn Fraga, director of the local health post who has not been too helpful in the past according to &!A who believes that JF feels that he hu@t to be on the payroll of the yf service. Find very inad- equate installation for handling fish. Rode through large areas apparently almost uninhabited today between SK:0 Miguel and Penedo. Sleep at SBo Miguel with mosquito nets; plenty of foci right in the hotel. August 17th. Sunday. Visit ANADIA again my first visit being on May 19th when I was here with MA investigating suspect yf; we came to conclusion on previous visit that the town was free from visible yellow fever and today three months later were able to learn of no further susp&cious cases. Also visited the nearby village of Tapera, also under suspicion on our last visit, and learned thet here also nothing further has happened. Stopped at PINDOBA, 16 kiltieters from Vigosa, long enough to satisfy ourselves that there have been clinical cases of yellow fever here during the past three months; it is hard to estimate how many cases or even how mcany deaths there have been here without making a complete study of the place. From incomplete information it would appear that some five or six adults at least have died; &&P&en generally don5 count in a case of this kind here. Our rapid history taking included one family whero some six persons had been ill with no fatalities. We were also told that 'many people were sick but few died and that almost all the children were illft Pind6ha is a small place with hardly enough work to keep one man busy. Service has been organized and will be continued until all immediate danger is over and then will be kept under observation and occasional inspection. Spend night at VICOSA; no recent cases of yf have occurred and the index is nuw down to three pn The incomplete studies of HA indicate that there were approximately n Vicosa from February to June with about twenty deaths. ~--cc--..---~-- August 18th. MA returns to Macei. on morning train because of infected leg needing rest and medical attention. ERR and I drive to Quebrangulo; much more of a town that we had expected; for all practical purposes thznd of the railway branch and a strategic point. Then to Palmeira dos Indios, the Queen of the Sert& which is also quite a town for an interior point. Control service was maintained .. here from August 1st to December 31 last year because of suspect cases occurring in) June 1929. On to BOM CONSELHO where we find the guarda working in plain clothes; ._I reports all quiet here. Sleep in Garanhuns. Au,pst 19th. Return Garanhuns Recife visiting SBo Caetano and Bezerros services enroute. Arrive office 415 PM. Bigo wires Mage complete with many refusals; wire for him to report to Recife, leaving sera with Davis in Bahia enrroute. NCD; I%UJOEL SUJTOS PAR& positive. PJC wires MS had leprosy, malaria and had been dead 24 hours before autopsy and requests reaffirmation of dia,gnosis .rrom NW Yellowing wire sent NCD;"Crawford reports Kanoel Santos had malaria and leprosy :toAutopsy performed twenty four hours after death stop Would this inform- ation alter your diagnosis? Soper." August 20th. Authorize Rio to continuesending 15 cantos per month to Cearg. Application was made on a patent on an "Extractor de Fragmentos de Visceras de of Dr. 3. l'omaz Alves, pub- lication occurring in the Diario Official Aggust 8th page 15524. Took ossession of the.new office and went to work. *-.L&./-" w 10 at NCD request that future shipments of monke should come in individual compartments; he reports getting %inety seven live monkeys out u of one hundred shipped on last shipment. Of course this is the most favorable season of the year. Robinson informed that we can order the ten kilos of tr?yparsamidc he desires for ma1 de caderas treatments but that shipment will have to be made to him and duties paid on importation. Following estimates submitted to FFR for 1930 Br. Phys. 18 cantos 2160.00 Wursing 20 2~:oo.oo Office 50 6000.00 Lab 65000.0@ YF 2500 300000.00 NCD; Joanna Rodri,gues, Par&, negative. NCD copy of letber to PJC asking for collection of blood specimens from Par6 for filiariaris studilr r,? Zrly- 38t!i rcc,oived; I believe such matters should be approved and arran,ged by me rather than handled directly between the laboratory and the field units. Shall discuss the matter with Davis when next in Bahia. NCD letter July 26th," Upon my return from Par& I allowed myself to be per- suaded that ,the Santos case had malaria only. lsQy present opinion is that vellow fever is present. I still believe that malaria takes a part in the picture. However, probably most of the pigment is the result of foma%tifixation." This refers to the Maria LWORA SANTOS case, BELEM PAR& March 19th 1930. CFragas letter of Au,P;Ust 13th trsnslated and - Oorwarded with CY letter to &iC; WC apparently gave CF to understand that he did not expect to return to Brazil. August 22. Adi&se Rio and D!3W and PJC that I shall arrive in Bahia August 28. Bi&o sailed from Rio August 21; should arrive RecFfe August 27th. Biao lxil.1 spend a couple of weeks with ERR in Recife and then will relieve MA in Alagoas while he comes to Recife for further training in methods. MA has done very good work in Alagoas considering the amount of assistance he has had and considering the fact that he is a home twn boy; better cooperation from the local authorities can probably be secured with an outsider. NCD; Carlos Jo& Andrade, Par& protected Jovenilha Andrade, probably protected. Walter Gaisle, Ilheos, almost certainly protected. Manoel Pelletero, Bahia, negative. Arranged for NCBank here to order payment to St`andard Oil in Rio of 218t856$. .Pr~.--. and sent to Rio -autopsy-note for Q Saneamento.. \ -.--_ ._ -- .- DBW explains that he wished copy of contract to see if v sny'protisiion had been made for lawyer's services (Dr. Carlos Mattos, in the carrying out of intimacGes and fines. laver for the SSAP in Bahia had tried tocollect for his ser- vices in connection with collection of fines: ALBB had gone on record however as opposed to such payment and injlbsted that he must continue to do the work as part of the work of the regula r health service.) PJC advised that Chevrolet touring car was shipped him this week. August 23. Left Recife 8 AM for Parahyba with ERR; many mhlitary in evidence and some burned houses seen; many houses still flying black flags of mourning for the murdered president and some also flying red flag of vengeance! Reports are that all fighting in the interior has ceased althou& there may be. some difficulty next week on the day of the THIRTY DAY MASS. i Met Dr. Rodrigues Perto, who is now in charge in Parahyba; he re- Y ! ports service in good shape in Parahyba but completely disorganized in Cabedello 1 Present Dr. Rickard to Dr. Alvaro Carualho, now President of Parahyba, who ex- ' plains that he will do everything ;jossible to make the yellow fever service sue- 1 : i cessful in his state. Also present Dr. ERR to Dr. Guedes Pereira who promises to , Iii continue his interest and assistance to the work under ERR's immediate direction. 1 GP informed that ERR ~iy.1 return next week for the purpose of going over the ' i local organization and making certain modifications to conform to procedure at other points. (Intimation and fining services not mentioned today although this is most important change anticipated; atmosphere one of formal presentation of regrets over loss of President not favorable to definite discussion of details.) Returned Recife 8 PM feeling day well spent. FLs 1930. Auwst 24th. Sunday. Day at office. Wired Rio to make arrangements to purchase a copy of the RIO YELLOW FEVER FILM. ", Aug. 25th. Liver Antonio Joaouim Ferreira, FIRST RO- AUTOP@ SaQ LUI 2 negatim NCD. POWER OF ATTORNEY made for JTA to receive from treasury 33 cantos due DNSP. Advised Dr. Bailey-to sail for Pernambuco rather than kio;scheduled to arrive in Recife Oct. 22nd on Almanzora. FFR advises of suspect yf in SANTIAGO CHILE in May. I consider impossible but am wiring CF and JBB for details. Demonstration tide1 of LIVER PUNCH sent bv airmail to FFB. August 26thnay at office. *B eave 10 office without &Lnl.erican in charge; suggest JTA be BONDED to handle all financial affafts. NCD Aug.21: "In my opinion postmortem changes, malaria or leprosy considered individually would not account for the antos; whether or not the canbination would do the tri ostmortem changes are rather marked, bllt there was undoubtedly a pre-existing injury. There is a little pigment-not lnearly so much as in some of the N,Ital cases. Eu'; there is r!uch fat and ,'.:- ' ?'I-; I-," -tls ccl.3. columns in in t,he midzones / There may not have boon much actual necro$s-;-l%-is rather hard to say now on account of postmortem changes. Bowover, th.ore are inflated nuclei, fading,nuclei, etc., some of T,M.ch rqy have been present ante-mortem. Under the circumsttices, and considering changes of undeterminable degree, perhaps I should have said, Qd ry gostive of yellow fever." That is still my opinion. 'fle shall be glad sug- to sh%T you a slide later."( Th' 1s refers to case noted this journal 19-8, (-T & P .&&%&-Cm! J August 27th. S ahia. Dr. an. &!rs. Cross, Mr. and Mrs. Goodman, Mr. and Bars. Gillette and Mr. Tate on board. August 28th. Met.by Dr. Wilson and get to Pen&o about midnight. JTA advises SANTIAGO CASE not confirmed. August 29th. With DBW call on the minister of Health, ALBB.j who service as so ation! (Incidentally this full cooperation began aftor CF's trip which time CF reported to the Governor that ALBB was,:not showing is quite friendly at pres- him an instrument for his been giving full cooper- to the north last year at the proper spirit; the I Governor at that time promised that no further passive resistance would be encountered here.) Discuss looal situation with DBW and authorise opening in Ilheos since NCD ' c has reported protection in ticipation of extended programme suggest that surveys be made are close to Bahia and would logically be J the first point of attack on extension; Alagoinhas, Cachoeira, Nazareth, Santo Arnaro and Feira de Santa Annna. In connection withnheos, Itabuna is to be surveyed and possibly worked. DEW suggests that as part of the survezr, larval counts be made on 1000 oon- tainers in each point; on consideration we decide to do larval counts in Ilheos only for the present but to have such counts made weekly thus foliowing the improvement with work both frczn the house index and from the mosquito production points of vievr. Rumour has it that the Ministry of Health may change hands with the advent of the new government in November; Dr. Afranio Peixoto, at present Federal Deputy from this state is the most talked of o-y Dr. Peixoto is well known to our service and is very syaathetic to the cause. Decide on 1:5000 scale for BAHIA MAP. AugustBOth. - Day spent at the Laboratory at Montserrat. Frobisher's monkey still survives its protection test seven days after inoc- ulation without sign of fever while the controls and other test animals of the 8811~ series have either died 31' are velp~r sick; NCD believes in value of large doses of immune serum early in the diseaue. Ma& 'study practically complete; MF would like to secure further bloods if possible for one year after studies on complement fixation. MF "has been working on chemistry of fat in monkey liver; Asks if any results from Wakeman's work are available; desires pure Hexylresorcinol. NCD reports that MOUSE STRAIN was not lost but that his animals are still FLS 1930. August 30th. continued. dying from mouse typhoid and that the patholmgy of the animal with bothmoane typhoid and yellow fever is not greatly differ- ent from that of the mouse with typhoid alone! NCD is rather pessimistic regarding the possibilities of the mouse work although he now has the virus well beyond the 60th trans- fer in these animals. NCD and I discuss in detail Shannon's proposed trip to the Amazon Valley@ I finally approve the trip as proposed on August 7th but with departure from Bahia only after the preparation for publication of material now on hand; RS estimates that such pre?aratiar should occupy him until the middle of October at least, without taking into consideration the systematic working up of new species collected. Departure from Bahia then should be about the 20th of October. NCD believes that the entomological work of the yellow fever service can be more profqtablg done by-a physician who knows some entanelogy rather than by an entomologist; obsoure species oan alTsaays be forwarded to specialists for classification;NCD is not then requesting the return of Shannon to this field. NCD and I have long frank discussion of position of laboratory in regard to rest of yellow fever service; I suggest that we attempt to mantain contact between the laboratory and the services away from Bahia through me and that the same procedure be used regarding contact with the New York office. It is true that I shall be travelling a great deal but with improved airmail service no great delays should occur, especially as I propose to keep NCD constantly informed by wire of my proposed movements. NCD insists that l&oratory is equinoed to handle large amount of work from the field and rather ohallenpes the controlmrvice to net enouph autopsies and bloods to g~rm%p;the works; in regard to ep$demiolonitiudies of immunitv distribution, HCZD says the laboratory could well handle two hundred monkeys per month rather than the one hundred now received. NCD has been able to demonstrate variation in 'extrinsic incubation period' of the virus in the mosquito with variation in temperature at which mosquitos are kept; his ability to shorten the incubation period by increating the temperature may explain the case reported by Brag&o in which the incubation period was apparently cut down to four days! NCD cmplains that no information is sent out regarding the work being done in New York and in Lagos and that there is no effective coordination of program by the three laboratorie$ as was anticipated last year. 1- August 31st. Sunday. September 1st. ANALYSIS OF "SALUS" scrapings by Inst.' OS. Cruz. Bahia. MO. 268, Anions: Chloro, . sulfurioo, phosphorico, silica. Cations: Sodio, Ammonia, Calcio, Magnesia, Ferro, Aluminio. *, 8th Dr. A. Diniz Gonqalves. ( And the propaga$z justifies the high cost of these jars because of the silver used in their manufacture! !!!!!! ) HOUSE AM spent with Dr. Qardoso inspeoting~gutter gangs. Five gangs of five men each are inspected by a guarda chefe. All gutters are na%rally dry at the present time. As the work is considered vital however and as the men cannot be easily replaced, the work is going on as usual but at a somewhat slower r::te then previcusly as each gutter is being flooded by hand to determine whether it wji.1 hold rainwi-:i:' (_` I.$ *. T:c I: :'lt%'-T*? holding water are punctured with the consent of the p~?ios concerned!; :.&ore gutters cannot be punctured legal7nachinery is set to work to require the necessary corrections. As the local au5horities are giving good support on the enforcement of the law, it u;ould appear that even during the rainy season it might be well to apply the hand flooding test to all @tters examined so that a uniform.basis of correction might be had. Of the five gangs visited, in the imperfect gutters; three were found to be punching inadequate holes EC insists that this is in spite of repeated instructions to make the punctures as large as the drain phpes. The gutter can-opener invented by one of the guardas seems to function very well when sharp; so that one may always be sharp and in service. I suggest furnishing two to each squad