FLS 1938 LETTERFROM DR.SoPRRTODR, SAWYER ~TTJWATFNtTALEZA, GEAR&,-OR SURVEX F'ortalear, brd, Wmtber 23rd,1938. Duar D?. Sawyers Dr. Wileon and I left Rio on the 13th aa planned in compupl of Dr. Evandro Chagaawhohadbeenover theworstof the~infeclted district a couple of times during the past six months. We remained in Reeife until the 16th when we mum on to Ratal by plane. At Natal we,,~~~ were joined by Dr. Hanoel Ferreira, recently aade head of the Fedsrrl c'b--~ee.~- Service for Malaria in the States of Rio Grande do Rorte and Ceari, a&L-G,--& by Dr. Valerio ~ondez, the representative of the National Depsrt;ment of 'kyc;* Health iu the State of RIO Grand8 do llorte. Wo left Rata 1 the mne moxm- ing snd slept the first nightat Aasb after visitingS%o Goqalo andBaixa Verde, both of whioh points have had heavy outbreaks of au&&a following the introduction of m to the region. lakeo &out And - The following day we visited the lunched at Ifoasord, drove to Russas for dinner, At Russas we met Sbsnnon and got a mmmry of his findings durirq dlmost a mormth's investigation. We spent the night at Uoeiro end on the 16th worked up the Jaguaribe River, through Jaguaribe-Miriar, Ouro Branco and Icb to Lavras, spending the night at Cajamiras &at over the linta in Parahyba, becauue of better Hotel facilities outside of the g,&&6 district. Since Shannon*s work ahowed that m was present at 1~6 but absent from Lavras, we decided to investigate the uonditiom between these two totrn#* Shannon thought there must be soae natura.3. barrier which had ~revanted the extension of the species UL, the river beyond 106 although there mmned to be dlozne epidtiological evidence to suggest that Had only recently arrived at Ied, The uaravan am divided into ;>wties, Rrs. Manoel Ferreira, Ga&ko Caesar and FLS worked the River Yachado close to Lavrrsl River Selgado close to Ouro Rranco, without finding aqy evidence of although larvae of other enolhelinos were found. Drs. Evahdro Ghagaa aud Vtierio Konder investigated possible breeding place@ along the road between Icb and Lavras especially in the first ten kilometers bel..w Ouro Branco. I~IWXOUS foci of other anophelimm were found and a fairly high incidace of tild endemic malaria was revealed but no evidence of m wa8 found. The third group consisting of Drs. Shannoe, Rouanet and DBW began to work the Salgado River about ten kiloaeeters above 106 and worked down the river to a point about five kilometers above this town without finding larvae. These results all agreed in confirming the absence of Jtarpbisa fron the River Salgado above Icb. The caravan retired to Iguatb, which YCXJ will rmnember from 1934, to spend a well earned Sunday loafing, sleeping and believe it or not, pley.&g Bidou, 1958 On Monday the 2lst, we lost part of the aaravan, the reinaindsr being divided into two groups to further investigate the region above and below 106, The previous work had left 801~8 doubt as to whether at Id had coDte up the river valley frolp pool to go01 or had made from Jaguaribe-Wirim by rut-bile or truck. Shannon, Rouenet and I went up above Iab and began working down fron the point &ere operations had been discontinued two days before. Within a few hundred yards of the point of beginning Rouanst found larvae. A careful ~se.r& by the three of us gave only eleven from three small pools and all apparently of the 0ame ege, The uniformity in size caused Shannon to remerk that we sight very well be dealing with the progeny of a single female. A recheck @u-t retchworkedtwo daysbefore failed to reveel anynissed foci af Before leaving the river four or five houses nearest to the foci whi wewe found were searched for adult In the last of these a single female wau found which Sh ounl?ed & multi- gara thus conf~ his original belief that we were dealPng with the original invasion of this gotit on the river by amingle gravid fenale, In the seantime DBW and GastWo Cesar worked the River be1.w Xc4 about Bebe- douro, finding PrupbiilE) at all sints investigated. Apparently the ;raar~h of this species is in this ome at least directly ug the river bed. Yesterday, we visited the lower Jaguaribe Valley and the town of Araaaty and came into Fortaleraa, thus CoAC&udihg this most intereating field trip. This morning i~e learned that ound the other day by one of $kwulOA'S men west of q&x3d~. eeable news but only serves ia smphasiae the fact that once the s into a river m&fey it wiU. spread uy, that valley uuless blocked at some point by natural or artificial barriers. I am enclosing here-&th Shannon's seven paf6e report on conditions in Gear& as noted in his work up to the 17th of this month. Were he writing it todarJr some alteration would be made regarding the importance of iqounded water and the resUltant irrigatien difehea but otherwise it would remain just about as it is. 1 find it impossible to be es optimistic about final results at as early a date as is Shannon but cannot force Hiyself to be entirely pessi- mistic as to final results if we are able to avoid the spread to the Parnahyba and So yrancisco River Vallzeya. The emount of work to be done in the areas &8ady infasted and +.keateued is enormous; whether final eradiccithon ia yoesible or not, I believe the effort will justify the expense in the actual reduction of malaria in the region during the time that oi>eratikfis are carried out o The most hopeful fmtor in the whole situation is the small ,xoportion of the total, infested area which is capable of year round breeding of any mosquitoes. Much of the States of Gear& and Rio 8randa do Worte are as you have seen covered with e dry desert type of vegetation called ca&knga . The ca&inga areas have very little cultivation exaept right al+g the river beds or where water can be put on the land artificially. And oven along the river be& the available breeding places are reduced to a minimum b, the long dry season each year. Qur Wip threughout the infee%eU CLM)(L pohcided with Dr. Berrsto*s trip through the pl&gue regiona of Pernembuco and Gear6 on th8 final lap of whhh h8 sp8nt one day in the district looking thinga over with Dr. bmd. ~~~8ir~, who is arr V0 th0 Dir8ctOI' Of thEI &%Ci tederr& &&&%a %rv'ioa orgsniaed just a 48W W88kS ~0 to 8ttaek the problaas, Izate, this afternoon we had a four way discussion of the si with Ferreira, Barreto, Uilson a;nd myself ~remmt. Barreto opened his re- marks with the statement that he had always bests in favor of the fullest cooperation possible with the Rockefeller Fountiation end that he kop8d come wry. could be found for the Foundation to Mx@c th8 m problem. I aaid frankly that I had ho28d that w8 might hav8 a breathing spell to clear the befads before jumping from yellow fever into something ebe but did &&c&t tha;t we hard been considering what could be done abou learning of the 8xtensi state of Ce&rli and the pred3go3t extension 0 I fe8Ithatarty f&lure tot strps would be UriaPindL if meaner can be mad8 available for immediate action, 4ft8r Barreto*s requ8et for a proposal I state that I hare 'no authoriaation to enter iat0 definite commitments without consulting the Hew York office but that after We week*s experience 1 ~GI willing to qqnw& to the Foundation for fwds ianrrediattiy with which to aollaborate with the Government irk the orgeaization of control work if he and the other rssponsible authorities desire suuh collaborstbn. I give 8 tent&tiPe estimate of budget for I%% at sewan thewand oontea (eTproxAma%ely $~50,000.00 USA ) of which I *pL willing k, request two thousand cantos from the Rockefellsr foundation if the Covernm8nt 1s willing to contribute with the remaining five thousand oontos. I 8rplain that this eetimat8 ia ~0kh.b~ more than a shirt cuff cticulation but that it should gtip&it .&he OZgnnf%atiOA of 38 muoh of th8 serrioe as *ox&d be posaibl8 under am,y clrcuwt inai& that th8 aervioe should be organiaed &f( an rather them 88 8x4 8xhi-imlaria service 80 that al nrairtia but not- would not feel fr8e to insist on having &ttention fl?Qm the SWFiO8j also, the servioe to be organized should not have the r8sponsibility fox medicaX care of the sick in dispsnearies or otherwise. &3B objeats to this point but we 8,ll finally agree that quinine will have to be diatributeb by field ,>eraonnel wor&ing in infested districts. Sine8 the in which to develop a separst8 organlsation I suggest that the service be orgtioed as part of the Yellow Fever Serrice, thue perm%tting u d on the enormous experienca of this rerv%cs in this very area. %a AOW in dirrtriots which have had to be organized for the controA of m in rural areaa). Also, and this is most impor- tant, the SFA has a group of trained RUSA who are accustomed to working under dlsoipline which can be drsm upen for the ~uchwa of the new service. The idea of the SF1 taking over the m probleria appeals greatly to JBB, who, we 1%&m, is mmio1.18 to avoid having his fire thousand conto Inalaria budget of next year broken into, dthough srt least one thousand cantos of it had been ear marked for Ferr8ira*a work. JIB suggests then that we write th8 y8llow fever aontract on the basis of 15,000 cantos for the first nine months of 1959 and depend on getting a supp1merWu-y budget later to com$ete the year. This suggeajition is unanimously mjsched by myself and I tell JBE that 1 em not willing to mix yellow fever and malaria budget8 this year arinc8 we 8re turning the yellow fever service baclr to the Government at the 8~d of the first semester of 1939. ..;_&,,.&:$,F,i ij+,.*;- ,:x ' ," '$4 : L:. ;'j,&; .p ' 1958 To get on with the story8 We 611 finally -reed that the pr8s8nt situation raquir8s imm8diste organization, that the proposed budget is 8 reasonable one until further information is scquired, that the present sewice under Fsrreira should be taken over, there being AO obli- g&%ia OA th8 w of the service %Q be orgsnised to keep mde&?&bls 2er-- SOnAel, aad t&&t t&8 m& b8 WBBd to mother the A8W OrgsAix&tiOA during its first mnths. Bsrreto sod ICerrcrrira sre stopping off in HatsI. tOmorrow sod DBW and I are to proueed to Rio to get action as soon 88 possible. 1 pro@se to Ssnd information to I$8w York im88diately for 8arf;y aution. In regard to the centml government, I cm gay Ft etverything indic&tes &hat there will b8 no difficulty in gettiAg theVAeceSSsry budget md fn tekfyb over the m control problem. I told Barreto frankly : / that I hsd ts&k8d th8 situ&ion ov8r with the Minister of EdueatioA snd i 1 : He&?&h sod hsd promised to m&e sugg8stioAs on our return from this trip. 1 j I did not tell him that th8 geOr8t&?Ty to the President had communicated \ ! with me the efter~oon before leaving Rio, StatlAg t&cat we could count on 11 ] I full support frm the exeoutiv8 srm of the Government! In regcrrd to budgets I believe arrangements cs.n be m&e to nuke sll Aecesssry disbursem8Ats this y8sr from the budget which Ferreira s.lresdy h&e &v&ilabl8; (E(ucs of thematerieSw8willw~~ to purchase cannot be got&m before ~8xt year in say cs~s snd usn be charged to the 1939 budget. 118 stated above I wish to reco%m8nd a one hundred #ouSsnd dollar budget from the Found&ion on the bagis of five thoumud cantos frola the Gove&-nmeAt. Thus, if ST$ memory is correct, the requesti; now atmad at one hundred fifty thoumnd for yellow fever +I cm8 hundred thouaauxd for for BraSil, I 81p cabling you from Recife tctaerr6wt Reqwlst suthoriwrttion proposle gov8rnm8nt immediate gsmbiae orgulisstion Budget 1939 Fmmdation $100,OW~3O Govepnrpcsnt five thousand cantos AAswer Rio - sop& There can b8 no doubt that we sr8 ssking for sA enormous h8sdsch6 for quite son% tim8 irp offering to organ;lee this progrsmme but I s8e no wsy to avoid the issu8. bnd if work iS going t&t be dOng it m)SSt b8 ~QAB on as lsrge a scde as saaible froa the beginning. men we uaaae north (I think you should know this before deciding to authorize the amount asked for) w8 fmx& Shannon thi&ing thst it would be useless to sttem$, to do aaything this dry sesson and fouAd Ferreira pls~ning on s full yesrts StMy of the situation before uAdertsking aoatrol, InCideAt&y, or no this field is very short of perSonne1, A f8w good men in the yoMger group who could be in trsining for th8 future are iAdicat8d, Likewise, I believe that Bates could be of more value here in the future than alnost mywhere else. Shannon ie up hers rulw and is very mu& interested in the whole situation but in the meantim the overhmd on the yellow fever laboratory goes on without piany thing8 being done which Blight be done with aore technical personn& Fortrleaa 2Srd %N9.f8 24th Very siAc8rely yours, Fred L. Soper