12.

April 30th. oontinued . the type of oooperation neoessary. His transfer

to TB is then one of expedienoy only. The nomination.at the ssme time of a teohnioal aesistant in the TB servioe, whioh has not had previously suoh a functionary is equivalent to aalling attention of the whole world to the faot that Pedroso is being put in TB rimply beoause he oannot be legally ousted frcaa the department, and that CF regognises that he has not the neo- essary qualifioations for the position to which he is now going. It is also believed that Dr. da Cunha will feel that he has been demoted by being trans- ferred from the Dire&ion of all the laud se-e8 to the Mreotion of the Maritime sertioe; and undoubtedly the transfer of Dr. Jo&o Pedro de Albu- querque from the Mreotion of the karittie Servioe to his old position of Inspeator of Phamaaies and Ydiaal Praotioe is a heavy blow. Some doubt is expressed as to the destiny of Maurioio Abreu but the belief is that he will take BsdrA%berpO da Cunha' 8 place as Mreator of the Land Saaitary measures.

R&S oalls on the phone and makes r,eaonrpaendations for a subsidy for hi8 8,dministrator and seoretary. H 8 says thatunfortunately he is afraid that the results of hi8 finding8 on the 8ea were partially repponsible for 8~ ef the shifts made in the DNSP/ This he regret8 but insist8 that he oould not do otherwise where human life is at rfake.

itioally and every other way. I personally was surprised that CF dared to / 8uggest the possibility of turning over the rest of South Brarril.)

Spend a couple of hours in the morning at the DHSP drying the blood of Hair withthe help of Dr. Hario PagaMes. Dr. Pialho's 8ohsme 8eem to

'!

have giveri very satisfactory results. It merely remains to be seen if this 1 virus will get to HT alive.

JTA and JAK rpend a few hour8 getting blood from 513 Ualdemar IJio- !

&au, d Lavradio 182, and from 522 Braile Basilio, B. Gen. Caldwell 194. 1

* Both of these individual8 were left in a good htlmor snd JTA says he can reg i

peat on the m in a mollth. ; Miss BP goes to hospital for the purpose of hating her appendix

rsaoved but ocs8es away again when she learn8 that Dr. Pyle8 broke hi8 leg .today and has urgent need of her ram.

EP report8 that both Pedroso and Albert0 da Cur& are not going to 1

l

' ac&pt their transfers in the department. The shakeup seem8 to have been entirely unexpeefed.

Q ‘

.~~

oubts $n regards the final' disposition of the SP personnel; Dr. Plaoido Barbosa has been made Mreotor of the Sanitary Sex-vises of the Federal Diatriot and Dr. Maurioio de Abreu takes his plaoe as Inspeotor of Prophylsxia; Dr. JJba. de Arag& beoomes Aseistant to the Direotor and Barr08 Barreto beoomes General horotary.

From a finamial StandpOint then no one loses exeept J&o Pedro and several get an inorease.

Mar 2.&.&Q&&& ,1X?otias reoiived'that Beeuwkes will arrive here Saturday on the Andes.

Dr. mh lunohes with me at the offloe and reports that he is ;e@pcmsible for at 1% part of the ohange in the DWPI Insist8 it is too bad and all that but that he oould do neither nore nor‘less than he did. He believes that J&o.Pedro wa8 to blm OnlJr so far a8 he conaided in the report8 of his rub- ordinater. WSA does not believe that he was wilfully IUi.SiafOX'miZlg CF as to

13. lay 2nd. mutimed.

the situation ht eea'i it 8eom8 that Ernest0 Par- auhos had been direoting this servioe only six days when USA dropped in on hi8 first day’8 fisoalisation. WSA says that he is now 6pending his days organising the aervioe at (lea but that EP 18 not 8pending wry muoh time there and that on08 he ir gone the sersioe 8LuLpot be expected to run itrelfi that he has told Ep that he till have to bemme f'ull time in order to handle the rituation but that Ep ray8 idbat he mast then rerign

WSA rhous a list of yester- infe8ted with rtegs and a tot-

al of 66 foai found on these 17 araft. WSA sayethatscrnethreewseks ago RoahaVaxtold himthathe had

inside informaticm to the effect that the President had giwn CF an abrro- lately free hand to make sny ahages in persozxuel within ths department whioh he thought to be rU8essaryo Thir indicates that the reoent ohsnges were not made oa the spur of the mcsaent but were in the proses8 of being planned for rome time.

8 other ocmfidential

Voted two hundred contos to help the state in the losal fight against yf. cI Have a long talk with De810 Parreiras this afternoon/ Today isthe-’

first time I have seen DP since early in January before anything began to break in the -All reports haw been to the effeot that he wa8 the one man doing the work in that state and that he had been working day Ih and night. Today he oertainly looked the part; unshawn,unksmpt and with a & look of physical exhaustion. DP quite frankly admits that tke oontrol of mosquitoes is not the easy thing it is piatured to be in the text books.

In regard to the aotual situation in the state, he says there haw been \ of the year up to and 8 have oaourred of b

ge number of places m* IgtUlrsu,Mag~,

Viahteroy, Vale-5 Barra Mansa and S9co Gongalo havs given series of seo- sndary eases. DP estimate6 that’there are about sixhundred pCuardas at

the etaasnd that about thir* operating expenses g paid by the federal gow whsn the first oase

or two are *rifled in a locality that the muniaipality give8 samething for ths setioe and pramises muoh more but that the munioipalities oannot be aounted on for oontinued oontributians and sustained interest. (This fits invsry well with what CF told me about the Federal oontribution to yf in the state and with the statement made by AA that DP had reaeiwd order8 from CF to spare no expense but to keep yf within bounds in the state.

make8 a msmark whioh gives the d&finite impression that here may hare had something to do with hi8 being

x&s that he is to be married to Dr. Fraga’s daugh-

May 3rd. JTA and JAK spend the moqing bleed- me eonvalesoent. Miss

mllen is operated by Dr. Jorge Gouwa. Today i8 a holiday being the Rnansipation Day of Brasil. JAK and I visit the IBIS in the afternom. Leaw word with Dr. AragU for CF that Beeuwkes will arriw here Sunday. Bswspapers oarqy ths notiw that Dr. Albert0 da Cuda has refused to aooept the post of director of thcr BQaritims SerMcre and that Dr. Laoerda has been appointed instead.

lllswspaper states that pati8nt at 678 Barata Rib died day before yesterday.

we i$G-b b--&-L-f,+,

-14.

iay 4th. r:

J.A?K.m mosc&to for& in fo_rtY-two houses visited,bLtl$-. ,' four of which were Stegowia and eight of which had pupae. Three guardas are being used-for a service of approximately five hundred and fifty houses; these men are working without lanterns.

Pedro Ferreira Meto, Rua Frei Caneca 525, presented himself for bleeding at the office to-day; can be bled again. Manoel Paula Dias, Rua Candid0 Mendes 295, bled yesterday; is willing to give more blood.

May 5th, Sunday. Doctor Beeuwkes arrives from Bahia on the "ANDES". Has an

attack of what appears to be Malaria. Is put to bed at the Hotel Copacabana about 3.30 in the afternoon. Doctor and Mrs. Waldemar, Do&or Kerr and Doctor Beeuwkes dine at 125 Rua Bolivar.

6th. May Do&or Beeuwkes somewhat better, but has a ohill in the

afternoon. Remains in bed all day, taking quinine. Is visited by Captain Warner.

Doctor Beeuwkes discusses quite fully his ideas regarding the situation in Brazil. He believes that we are already working our Amerioan personnel too hard.and that it is axake to keep men in Brazil without vacations, when suc& vacations are due. I--p se neem least six- if twxte

H.B. estimates h Brazil, as

propowcost of service in Rio de Janeiro at 50 cents x capita per - yy. ---- -

H.B. is quite surprized to find the index in Bahia and Recife as high as it is; he finds it difficult to reconcile an index of 8 in Bahia with an index of 8 Of 1% in 1924. P-Y"-

H.B. says M.E.C. believes S.outh Brazil may clean -elf <<w&th a hem winter 7 and that M.E.C. does not care to work

ond July 1930. H.B. believes that South Brazil c_ by the R.F. lightly, but only after oareful

study and on entirely satisfactory terms with ample authority to handle such difficult problems as closed houses, military barracks, gutters and so forth.

H.B. says that a Yellow Fever La- in&-azil would c_- -- have beenthe_beginning bmuse of the reservation of tat Field for the Rockfeller Institute and Noguchi;

--------^- that Noguohi

even thought that t the Lagos Laboratory fromNew York. I - ----.--

H.B. r8ports that N.C.D. permitted six supposedly infective mosquitos to bite him with negative results. N.C.D. believes strongly in partial or relative immunity and believes such relative immunity may be mafntained by frequent exposure to infection. H.B. has no faith in this f;heo;lry. H.B. considers the application of

er Field work. ----

-150

the men are now working in Recife has to 12.0 and

been abandod from 1.30. to 4.30.

In discussing possibilities of epidemiologlcal study in Coryntho or Mag6, H.B. points out great expense involved in complete study of large group and suggests careful selection of group of approximately sixty individuals , representing both adults and chil- dren and confirmed and suspicious cases, as well as individuals who had never been sick.

Doctor Beewvkes insists that he himself does not expect to spend more than one more tour in Africa.

Doctor Beeuwkes reports that he found Crawford with attacks of vomiting , very suggestive of gastric ulcer.

H.B. reports that five deaths have occurred among the i African personnel:- Stokes, Noguchi, Younff, Wakeman and Mrs. --- Mahaffey. The first three died of Yenow Fever, Wakeman of a zerebral abscess, seoondary to a phlebitis, and Mrs. Mahaffey of diabetic coma. In addition two have been invalided home and I I .-__-_I - eleven are known to have been infected with Malaria. -------. ----. --.-

Call on C.F. and advise him of suspect case in Para, suspect case in German pension in Recife and of cases on board battle-ships "Bahia" and "Rio Grande de Sul" in Recife.

May 7th. Spend much of day with Do&or Beeuwkes at the Hotel.

C.F. calls on H.B. Doctor MOSCOSO of the D.N.S.P. calls on H.B. as routine of medioal vigilance adopted for all guests becoming ill in hotels.

Pictures taken of fumigation in Rua Barroso.

biay 8th. H.B for New York on "WESTERN WORLD". Doctor Juan

Pedro Albuquerque and Miss %-azil sail on same boat.

It is reported that the transfer of personnel in the Public Health Department w&s caused by an interview between President Washington Luiz an&D -- ?egarding the capabil

Miguel Couto_L 1Y.L. asked M.C. his opinion MC. replied that C-F. was capable,

but that others in the Service were not oo-operating well. W.L. then called C.F. and insisted on details , and as et result gave him a free hand in nominations and transfers.

Dootor S. Uohga calls regarding friend who desires position with National City Bank. He confirms the report that the choice of a director for the Maritime Servioe lay between him and Lacerda. U. says he would not have refused the position, but is quite pleased

-1%

that it was not offered. He confirms the zenera discontont in fly the D.N.S.P. over the recent shifts of perionnel -_______.- ---. l

--I t is understo re personnel at O.C.I. are thoroughly- _.--- -II___- -,

It seems that Albert0 da Cunha was notified of his transfer to the Maritime Service and accepted it

od

before leurnilmg of the other transfers. This acceptanoe ifas based on the special plea of C.F. that the Maritime Servioe especially needed re-organization. When he learnt of the other changes A. da C. refused to accept the post. Pedroso first learnt of his transfer by reading the notice in the "NOITE". S.U. feels that C.F. was quite unfortunate in arousing so rmroh antagonism at this time. S.U. is thinner than usual and shows the effect of hard physical work. He says the results.of his inspections have beeu+Fa.ng and that one -,. - physician has been?fZ%%?%i%~*fi~%l~Fever S&?ice as a result of them.

May 9th. Andrade presents pink vouchers for 1928 for my signature.

Find one Of Rs. 7:200$000 from Control included as Maintenance. Finally approved this.

Make arrangements for J.A.K. to go to Maoahd with Andrade on May 12th.

Visit O.C.I. H.A. reports CM R.F. will t&e over States of Rio and Espiri%o'&.&&.

lf -

Doctor Raul Magalhaes calls en route to Carangola. reports that Yellow Fe

HeyFb curred in fourteen places in the

State of Xinas this year. These places are as follows:- *mu -_qn~.i---ll--- .A___ -, --_

- . ..I ,_

STATE OF MINAS - 1929

Place Imported Secondary Deaths Guardas Cases Cases At

Coryntho Carangola Pox-to Novo C$L Cunha Pirapora S&bar& Paraopeba Juiz de Fbra Mathias Barboza Borto dos Flares Cataguazes

Port0 Santo Antonio Uhf% Ponte Nova Belle Horizonte Poqos das Caldas

1 1 1 2 1 1

1 1 1 1 1

31 10 12 7 2 9 7' 2 8

6

40 6

6

6 4

50

Doctor Magalhaes promises to return on May 14th to discuss the situation more fully.

May 16th . 17.

Wswspapers carry iterm that CF has asked Prefeitura of DF to do a-y with roof gutters in future oonstruotions.

Wire frost MEG asks that we prevent further extension of trip of battleships ABahia" and "Rio Grande do Sul" to the north beoauss of the appearan of yf~@ps at Re0ife,

Confirmed oase of-and" in Port0 AleAreA. -e-e--

May 11th. Correio says that the"Rio Grande do Sul" is already snroute frcss

Frolli. Fernando Eoronha to ths "Roohsdas de>&0 Pedro e Sgo Paulo" snd the "Bahia" .enroute fran FE to 'Bel&m".

CF reports that it is not feasible to attempt to 0hange the it- inerary of the battleships.

Wilson reports suspeot 0888 on the "Camsmii" enroute Santos to KY. '$ CF says that government is willing to turn over the states of _

Rio and Esp&to Santa to the RF, but is not ira=-j$&&%%0ffer Minas v _.‘. __-__ .- .-. G0raes as-.

We go to Petropolis for the week end at the hcnne of Madame Mes- quita, 191 R. Dmodoro.

May 12th. Wire MEG as foll0w8,

"Rookfound, Canor, Belsm. .B reosived extension servioe States of Rio and Es&ri.+o Santa. Probably Yin& Geraes later. Suggest you osoediately. Soper."

Hay 1Sth. Emawipation Day in Brasil. Walk to Independenoia in the mud. Joaquim Henrique Mafra de Laet, R. Caudido Mendes, 289.

May 14th. Return to Rio. Follacring wire from MFG:

cc DQ not oanmit our sgrrios without previous oonsultation with me. Stop/ Have reo0mmended against'tiragas suggestion to Russs& Stop. Can go no further untfl Am-0 May 14th. Stop. Connor.

Rtxssellepliea. Stop,

Kerr returns fromaMao&. Reports that mosquito situation is relat- ively good probably due to the excellent water supply. States that there are not as msny tile in stook as there should be aooording to our books!

May 15th. Visit OCI and HSS.

May 16th. ERR arrives on Southern Cross. I reoeivs frarm HA sera from the

follwing 0ases: Arthur Pereira,Waldsmar Eioolau, Manoel Paula Dias and Pedro Bsrrsira Betto. (Blood of Braile Basilio hsmolysed and that of AETBE?O PAaIl? FARIAS proved &be contaminated.) I furnish blood frQa two of these oases to CF and send about a dozen ampules with ERR for Juan Zuoarini in Buenos Ayres. CF also asks me to send Afrsnio Amaral serum. This I take with me, on Southern Cross.

Wireffraaa ET1

May 16th. Continued. li8. Conference with CF in which I explain the attitude of

MI!% regarding further extension of our yf sertioe. CF oannot understand thi-s attitude and asks me to write to RF& explaining fully the situation. CF oannot understand why there should be auy neoessity for the RF to enter the Bli'.<I‘ repeat what I had previously said to CF that I personally expeoted that the RF would %e wi'lling to take over all south Brasil s exoept the DF but- would not be willing th take over the States of RIO and Espirito Santo wit@& at the same time taking over the State of Minas and making scsne working a@ee- ment with the state of Sgo Paula. I still believe that this would be a very reasonable basis for extension, and knowing the looal situation as I do I believe it is the very utmost that oould under any oiroumstanoes be arranged ' in the near future.-For CF to suggest to the government the oooperation of the RF in the DF would be tantamount to oonxi&tting politioal suicide for all time to come.

May 17th. Arrim in MO Paul0 via Santos with ERR and family. Rain1 Disouss

future frankly with ERR and tell him that he may be needed in this field but that I slahll do everything possible to keep him in Tuoum&.

=Y isit Borges Vieira and learn that the'Instituto is progressing slow- ly but surely. The gcwernment has extendbd.the time for ocsnpletion frm Sept. 1 1929 to Jan. 1 1930. BV says that this de&y in part has been caused byt the failure of the engineer of the Institut to furnish rapidly the data need- ed by the oontraotor. BV admits that he has still on hand some four hundred oontos of the RF untouohed and that the Medioal Faoulty has a large unspent sum on hand. The view of the School frcm the street indioates that its oon- struotion is progressing sluwly also. BV has oome to the oonolusion that the Institute should beoafne more and more a teaohing institution and take less interest in the administrative side of publio health. The researoh of the Institute should be carried on independently of the Sanitary Servioe and no attempt should be made directly to influence the administration of that servioe. I believe this is the only orientation which will permit f& of the maintainenoe of independenoe.

Graoiotti says that Waldemar da Rooha did not aooept the appoint- ment to the position of DePegado de Sa&de in Guaratingueta but is still in the offioe in SP. He went to Piraoioaba today but will return Monday PM.

Visit Waldemiro Oliveria snd learn that the Minister of the Int- aerior has akked him to draw up an ideal plan of health administration for the state under present oonditions wS;thout thinking espeoallly whether such plan is finanoially practicable at the present time or not. WO shuws me a map of the state with his proposed divisions for the installation of full time health servioes. WO believe's it impossible for each etunty to have full time medioal men but offers as a solution fill time medical men for a health distriot oomprising three or four oounties. (UO states that he is personally oonvinoed that health offioers at least in the interior of the state must be full time!)

WO flatters my vanity by saying that he uwes a great deal to me for the information I gave him the last time I was here over the possibilities of yf extension to the state of SPaulo and for having pointed out the neo- essity of intensifioation of the antimosquito services in all important population oenters. WO went to Julio Prestes on the basis of my remarks and asked for authority to spend as muoh money as might be needed. This authority was given and servioes were rapidly extended. Sautos mosquito foroe was raised from 19 to 45 and other services proportionately. WO insists Santos has had no authoohtonous oases. My answer is that the service there must be very good then or that God is a Santista. ---

May 19th. Sunday. 19. Sunday dinner with Dr.‘Waldemiro Oliveira and family.

WO invites me to go to Santos to see the work that is being done there against mosquitoes. I agree to go on Tuesday. WO believesthat it will be impossible for Mario Pernsmbuoo to return to an administrative position with the present government. I do not discuss the possibilities with him as there is nothing to be gained until after,- returns. WO does say that he is trying to find a way out by which MP will lose nothing finanoially.

Sunday supper with the Bowe family at R/Brigadero Antonio Luis 317. Young King and Mr. and Ms. Gallion put in an appearance and help ohew the fat until a late hour.

May 20th. at the Institute Biologioo and meet Dr..Arthur va had left by the time I was ready to converse

with him. RL wishes to know all the latest on yellow fever. The only new point I sm able to give him is the one about the early infectivity of the monkey to mosquitoes. RL discusses the work of Kuccinski:says that he (RL) sent a laboratory assistant to work with him in Berlin and bring oultures of the typhus organism baok to Hamburg so that his work might be confirmed in another laboratory where work was already being carried on with lice in the transmission of the disease but that the assistant returned after some time without the oultures but with the conviotion that the work of K o#? typhus was cborthless; RL says that the American workers on Rocky MBuntain Fever have never published any oonfirmation of K's work on this disease and that the recent publioation regarding yf oarries illustrations of liver pathology whioh are not typioal of the ohhnges produoed by this dieease. RL regrets that K is coming to Brasil as he believes that it cannot fail to oause international hard feeling in the end and may even oause a split in the Brasilian soientifio workers.

Lunoh with Dr. and Mrs. Jayme Pereiea. JP hopes to sail again for the USA in July of this year. He has written directly to Dr. Pearoe and is very hopeful of approval by the RF/. JP and his family made their first trip to the USA with me in September of 1922. JP insists that the SS of SP is no better than was to have been expected.

Call on Dr. Pedro Dias da Silva and learn that the medioal sohool is not yet ready for inauguration but that he hopes to be able to open the sohool work there for the next aoadtio year in pluchh 1930. I suggest that he ocrme to the hotel and have tea with Dr/ Afranio Amaral but PD suddenly develops urgent business elsewhere and does not come* PD says that Julio Prestes will without doubt be the next President of the Republio snd intimates that he will in this case accompany JP to Rio. PB does not state his future function in Rio but it is entirely possible that he looks toward the Rational Department of Health! PD insists that he is shortly ooming to Rio for the purpose of seouriger remission on oustcms duties paid on materials used in the oonstruotion of the medioal school.

Wire Dr Connor.Ef@.s ion. Government doe-

"dell aocepts,yEr reoommendat- -e----. mrenio Amaral does not put in an appearance for the r.

serum.

21. May Dr.WO unable to go to Santos; I make the trip with Dr. Alcides

Prado who seems to know almost all of the RF workers in Rio during reoent years. AP is now working under Dr. Salle% Gomes in the Division of Infeot- ious diseases; ocsnplains that there are almost no faoilities available for laboratory studies in malaria whioh is higprincipal interest when not in yellow fever work. AP has taken most of the indices before the opening up of stegcDnyia oontrol in the state of SP during the past year. He says that the * -the of the summer di

of SP has never been high and that even in the heighth un more than six or eight peroent. Many of the in-

terior plaoes howem indices and merited intensive control m eas- ures. The index in Santos was pver 70 when work was begun last year. AP

rt time pay but by the very nature of his work is foroed to devote full time to the job.

We visit first the section of vigilsncia medioa. This servioe is

I f-4* May 21. continued.

in the hands of non-medical men who are responsible for finding their men and getting their temperatures. Every traveller show- ing fever within six days after arrival in Santos must be reported to the medical instector who then beoomes responsible for the diagnosis and isol- ation of 911 suspect oases. At present 11 inspectors at 400$000 each per month are employed in the city of Santos and 5 inspectors at SOO$OOO each per month are responsible for working all the trains both ways between Santos and Sire Paulo. From talking with the men doing this work I am con- vinced that the service is well organized and well administered but even so the workers admit that they are able to find and examine for a period of six days only about sixty peroeti of the new arrivals!

Lunch is sefved at the Isolation Hospitll with the presenoe of the folaowing medioes: Drs. Martin Fontes, Arthur Costa, Edgardo Boaventura, Dr. Antonio Arantes, Joto Carlos Azedvedo, Aloides Prado and Dr. Goglianp. After lunch we visit the isolati

receives one conto five per month and the two assistants one oonto or one con-to ho per month eaoh.) In addition Dr. Abreu Sod& is in charge of the ~~Q~ mosquito control work on the morros and the outlying distriots. Santos is divided into fortyfive distriots or rather sones and these fortyfive zones

\-

are grouped in two distriots each in charge of an assistant direotor. In addition to the medioal personnel, the following employees are used in the policia de focos:

1 seoretary 500$ 1 st&rekeeper 3504b 4 typists 300$ 46 guardas 350$ 1 chefe geral

!ooEJ 45 serventes 150#

1 ohefe san. 1 guarda docas 35043 1 ohhfe petrol. 4005 5 guarda docas 350$ 8 district chefes 400$

In addition to the aboverthe Cia. Docas furnishes ten servents to assit in the work at the oaes.

Santos has a total of 16800 houses and lots to be examined eabh week. The service is organized for the triple purpose of war against all kinds of mosquitoes, as well as flies and rats.

The index is calculated on the baslas of the mosquito larvae which are brought in by the guardas and at present is believed to be about 0.4%. I suggest to the medicos the possibility of checking with the guardas as well as behind them in order to determine the actual index. It seems to me that an index depending on the bringing in of larvae from all foci is

'difficult to get. It is much easier for a guarda to destroy a foous than it is to get sample larvae into a bottle and bring that bottle to the lab.

The service in Santos is also in charge of the expurgo but this is handled by a special crew of men numbering about fifteen at the present time. Also the removal of suspect cases to the h&pita1 is in the hands of the same service. The additional personnel needed for this service cannot be rightly charged up against the oost of mosquito control in Santos.

After a very pleasant day we arrivein SPaulo about six pm. Dr. Waldemar de Rocha appears and insists that he wrote me some time ago both regarding the final disposition of our file and his attitude toward the yf servioe. WR says that the file is in his hands yet and will remain so u until the return of MPernembuoo. WR expects to get married before the end of the present year. Would aooept yf service in the state of RdeJbut does not enthuse over the opportunity to go north Brazil. Acogpts two cantos for Rio but needs three for north Brazil.

-2Oa-

COPY' OF LETTER

No. 1304. May 22, 1929.

Dear Doctor Russell,

On %y 16th I received your wire in code, the first part of which was interpreted as follows:-

"Doctor &E.Connor is right. It is useless working new States, omitting most imjortant locality."

I have informed both Doctor Fragu and Doctor Connor of your decision. Doctor Fr:Lga states that the entry of the Foundation into the Federal District at this time is impossible.

The control of the Yellow Fever in the Federal District has assumed such an important place in the work of the Department during the past year and has been so much discussed in the public Press, that were the Foundation to be called in at this late date, it would most certainly mean the permanent political annihilation of Doctor Fraga. Personally I was surprized that he dared ask an extension of the Foundation's control zone to include the State of Rio de Janeiro in the face of the criticism, sure to come, should this invitation become publio. It should be remembered that only three months ago the new agreement was dravrn up and signed, providing for the limitation of the Foundation's activities to North Brazil.

I realize fully the validity of the arguments against the acceptance of partial control in a heavily populated zone. However, it should be remembered that we are already-,,cormnitted to the l_ll~ ..__.. ".,.*,." control of Ye1lo.v Fever in North Brazil,

-.. .- --. .e,_ ,^ ,. -_.-. the most important zdne of

which, from the standpoint of Yellow Fever control, is only t,vo days voyage from Rio.

In considc3ring the advisability of extending our service beyond the area now being worked, should be taken into consideration.

I believe the foilowing facts

for t&s purpose in less than twelve months. The present service of the and does not h

value for a comparison of methods and costs that a service as close as Nictheroy would have. It is, of course, one of the policies of the Foundation to demonstrate how work should be done, rather than attempt to take over an entire service on its o<fn responsibility. (Yellow Fever has in the past been an exception to this policy).

Although the results to date have not been safisfactory, it is entirely possible that re-organization of the anti-mosquito service in the Federal District may result in the succcsSfu1 control of YellovJ Fever this year.* However, I believe it very doubtfulTf the State of Rio can be controlled without the intervention of the Foun,dat&~, .,l .-' .-e- -_ .~/,..s%". .-

-2Ob-

It is entirely possible that should the Foundation take over the State of Rio de Janeiro and obtain good results from control measures, that the Federal District might eventually be offered, should the Goverment's efforts fail during the coming year. I believe that the extension of the Service to the South would act as an entering I / wedge, facilitating a unified Service at a later date. )&pdfi f434- /y - 61

Should the Government offer the Federal District and all South Brazil at this time', vie are not in a -nosition to acce* t-with available personnel. On the other hand, should we take over part of South Brazil at present, the extension of the Service could be made more gradually.

Very sinoerely yours,

(Signed) Fred L. Soper.

Doctor F.F. fiussell, The Rockfeller Foundation, 61 sroadway, New $ork City.

Copy to Doctor U.S. Connor.

-2Oc-

COPY OF LETTER

No. 1309. Uay 24, 1929.

Dear Doctor Russell,

The results reported by Doctor Sawyer in his letter of April 3rd on four Yelloiv Fever sera from Braz de Pina are ver- interesting snd have helped somewhat in the understanding of the situation in this suburb. 1 can say, however, that the results are not exactly those 1 had expected.

On the enclosed sketch map you will find the geographical location of these four cases, as well as certain other suspected cases indicated.

Henrique Dias, % Portuguese, lived in the same room with his nephew, who died of Y ellow Fever; Henrique, however, was diagnosed as Grippe in the Hospital.

Uanoel Dantas is a Negro, eighteen years old, who lived for the first twelve years of his life in Bahia. Two days after being vaccinated with the Araggo vaccine he developed fever, hea&:che and marked congestion of the eyes. lie rras removed immediutcly to the Hospital, but on the following day was apparently entirely recovered.

Carmen Fernandes was seen on the first da;; of fever and -iTas considered a suspect Yellov~ Fever case only because other cases were occurring in the vicinity. However, inoculation of her blood caused fever in a series of three monkeys, none of which died and none of which apparently had Ye1ioi.r Fever.

Djanira Azevedorwho lived right next door to Carmen, was taken -to thz Hos,nital, was x0-k severely ill and returned to her home wi-t;h a diagnosis of Grippe.

It is Indeed intoresting to knew that Doctor Sawyer found that only Henrique Dias and Djanira Azevedo protected mo-nkeys. I wish to thank Doctor Sawyer for sending us this information.

I am sending with this letter all the information available regarding the cases of R.B. de Silva and N.J. de Silva, the sera from which failed to protect monkeys, as noted in Doctor Sawer's letter of fipril 3rd. These cases both came from infected districts and were both considered positive in tho hospital. I ;im also sending you case histories of Jose Nunes and lbnoel %rques, which seem to give only partial protection franmonkeys.

ries and Case No.

-2Od-

of April 3rd as h:;ving given Leptospira cultures in the hands of Doctor Mullcr. This case was a?ltopsied, but the specimens have been mislaid in the Laboratory, and although I personally searched through some thousand containers, the tissues have not been found. The autopsy notes, however, indicate that nothing unusual was encountered to excite suspicion from the gross examination. I %rn enclosing with this letter also a copy of the available information on this case. l)octor Conror saw this case ;rith mc on February 24th or 25th, at which time the case was definitely considered Yellow Fever, but was believed to be of a mil< character. .;hen we returned later in the week, Doctor Connor was quite surprized to learn of thk fatal termination. I am keeping this case in mind and shall make every attempt to get autopsy material, if it wn be found.

Please ask Doctor Sawyer to send us the results of the Glover test, ii' the; are available.

Very sincerely yours

Doctor F-8'. Russell, The RockfeiAer FoundrLLtion, 61 Broadway, hw York City.

(Signed) Fred L. Soper.

Enclosures (6)

Copy to Doctor Savryer enclosed.

-2Oe-

_./ J 4-F . . \ Statiori

\

Braz de Pina

u,/

/

0 Suspect Y.F. X Positive autopsy ITD Iienrique Dias IID kneel Dantas CF Carmen Fernandes DA Djanira Azevedo

1

May 22nd. 20.

Arrive in Rio on the Cruzeiro do Sul, the all steel train which made its first trip on the 13th. Write FFR and MEC attempting to explain why it might be well to come south at the present time with out service. However I presume it is useless to get the idea acros8* However I doubt if it is wise to limit our field of action to the north nowi only the future can tell which line of action would be best/ Should Fraga remain in the Department, and present indications are that he will, the time will prob- ably [zome when our position would be muoh stronger were we in possession of the south. SUchoa says that Lintz is soheduled to leave the State of Rio. -Ld----- May 26.

Andrade says that Lintz is to leave the state of Rio i% the State does not build hislregional hospital; the sate cannot build this hospital at the present time as funds are absolutsly not available. Andrade admits that there is no ready explanation for the shortage in tile found on our reonnt aheok up of materials ; asks for 8n inquerito whioh I tell him must be nade by himself and that his findings must be brought in and be subject to inspection and survey by this office.

HA says that the transmission through mosquito feces has been proven. Euozinski is to arrive here tomorrow and is to work in a laboratory of the institute. Interview CF who agrees to MEC's arrival in Rio in July. Lunch withwaldemar Antunes who says Romero will go out of yf servioe soon* fiiay 24th

Quiet day at the office with tennis in the afternoon. Kuczinaki arrives in Rio. - May 25th

Inform CF that I have reoeived confirmation of the two oases on the SS Ferm in B&m and that the boat had touohed at both ReBife and Rio. CF and HA both promise me in the near future complete lists of vacoinated individuals who later suffered frm yf. Meet Kuozinski and YoClure at Oswald0 Cruz Institute where K is to work. B.A is rather nettled at the opening proposal of K to determine whether the African and Brazilian yfs are the same or not as HA has definitely etated in his publioations that they a& He is also surprised to hear K say with great pride that he had been able to infectY.ayncmologous as this is one of the first things done by BA last year. ( 'phe scene is all set for some beautiful eeientific scrapping in the near future I believe!!! I!)

May.26th. +d+++J@b* Ledoux to sail today. K spends morning,colleoting blodd. JAK recounted yesterday the story of STD'S death as given him

by Dr. Carley. The Foundation had f'urnished a car and ohauffer for STD in Palestine and the advisibility of taking the 8sme oar to Syria was oon- sidered but the idea was abandoned beoause of the matter of expense and also beoause the ocnmniasion was beocsning the offioial guests of the French government. The aooident oocurred on the return from a trip out of Beirut into the mountains; the oar was being dfiven by a military ohauffer who had not previously been over the road and who was loggy with wine when the return trip began; the top of the oar was lowered at the request of Drs. Darling and Lothian; the desoent was being made so rapidly at times that the passengers beoame frightened and on two or three ocoasions had told the ahauffeur to drive more. slowly; rounding a right turn whioh wae negot- iated with diffieulty beoause of excess speed.the oar was oonfronted with a sudden left turn whioh oould not h+ade by the oar; passing through a sparse narrow woods the oar took a flylna leap into spaoe and although it landed on all four wheels after a drop of only about two meters, the shook of landing was so terrifio that all of the passengers w&e thrown violently out of the oar; only the ohauffeur maintained hi8 position and was uninjured. Swellengrebel who was among the passengers was the first to reoover and went to where Darling was lying already in extremis (fractured skull); S found Lothian alive and consoious# able to talk, and give direct- ions for the return of a ring to hi8 fianoee; he also sent a message to his mother and signed a blank check for the use of the Ccmunission of &hioh he was treasurer before the end which was apparently due to internal hemorr- hage. S and the chauffeur took the two women of the party who were badly injured baok to the road and hailing a passing car sent them to the

May 26th. continued. 21. hospital in Beirut; one died on the way in and the

other after operation made a slow and tediuous recovery. S,&self injured more then he realized spent some days in the hoppital.

The triple funeral staged became a state function; the chief mourners in top hats and heavy black dress marched in the pro- cession alternately drenched by heavy showers and steamed by the terrific heat of the sun; special measures had been taken to provide religious services for each of the dead in their chosen religion, Episcopalian for Darling, Presbyterian for Lothian and Catholic for Mdme Lascelles(?)/ The caskets were identified by the national flags of each of the dead but through some unfortunate circumstance the casket of STD was draped in the French flag, that of Ydme Lascelles in the British flag and that of Lothian in the dperican flag. Only at the moment of taking the caskets on board ship was the mistake discovered; the French were then advised that other services should be provided for Mdme LascellesL

f the state of Rio de Janeiro came to the of- r the possibility of making epidmiological

studies in the state. DP suggests the following localities, Mag& with 18 cases in 1929, Nilopolis with 12 cases 1929 and 16 oases 192m as& with 27 cases 1929, -da -cases - I!if%x- 0 very close to Rio has had fifteen cases. DP says that in Merity it has been carataon to find f$.& a--tithe blood and the @a...&&~~ DP is qu e intereGG‘d~i;hx+the -8" will do everything possible to aid the project beginning today at which time he will speak to the secretary of the state about giving us all moral support. DP says that Lintz has asked for fifteen days leave but will not y, return to the state of Rio. Lintz was unwilling to remain in the state and have the yellow fever service taken over by CF.

Roite publishes an attack on CF saying that he had no right to send inspectors to the state of Rio and comaring the results of the work of Lintz with less than one thousand cantos to that of CF with much more money in the Federal District. Admits however that there have been more than

have-

Ichad Dyares bled at the office and blood delivered to HA. At HOC it is said that Kuceinski has already begun work inoculation two mo&eys with material brought by him from Berlin.

May 28th. Wire from Connor "Have written Russell regarding vacations stop

Kerr will not be needed in Yellow Fever at this time stop Should he be re- turned to Brasil after leave I would be pleased to consider him for this sertioe Connor' B~suuss prohlem of leave with Kerr and decide to let his

here in July for further discussion. to reccmmend the fellowship of Br. Aggeu

As is routine here all ones friends are called in to help one get what one needs; the letter eereived by Lafayette is very similar to the one received by me from Dr. Gouveia de Barros. L does not belie- i~~~~l~~~~~~.r..b ..dme . ..mrw aAt.& ig favq.r* o? flit ,."d, p@$T&e VW get~~~~,,g~.~a.ap,~~,~~~~~~n of fljtwhich is not an expanding

e -a~-~~~u~~~~~~~~,e~~t~_.9,fl-g~~~~y,fr_Fpn. t,&..tim? .&.S hwma .++. pistol; ""rr~~~~~~~~~~~~~,~~~.~~~...~~ RF 183 to take .owr .the.work in

. L gives the details of the Purgold case which died at the Rnglish Hospital; he says that although the case was one with high fever and severe symptoms from the onset that the olinicians made a positive diagnosis only on the fifth or sixth day shortly before death; this case * had been seen by Thcmpson Cotta and Pego de Faria both of whcrm are consider- good olinicians; L agrees that yellow fever is a disease which is very

22.

May 28th. continued. Jensen de Mello calls and says that the DBP yf

service has adopted his proposed forms for the statistical reports; that there was some discussion and that the opposition raised its head slightly once or twice but in the end the adoption was unanimous. JM is preparing a report on the statistical side of yf service for the Arohivos.

Work on the Argentine quarterly report.

May 29th. First reporton the yf service in the north under the present

contract prepared for the month of March; to be submitted to CF t=orrm- Dr. Lobe at OCI promises typewritten case history records in lots Of five

to be copied on our forms. L reports a very interesting case of a Port. who worked on Thursday, took sick Friday and entered OCI Hospital on Sat- urday afternoon. Examination made Sunday showed high fever, jaundice, oliguria. Blood examination showed 12000 wbc and only slighgly vcrer one million rbc. The coagulation time of the blood was within normal limits; the VmderBeegh failed to show an obstructive jaundice; the reduction in urine became almost absolute but without heavy albuminuria and without bile piments; the amount of complement was reduced. Bse died on the sixth day; autopsy showed normal liver; diagnosis has not yet been made.

Find- with HA end overhear him saying that he did not know of BA's success in infecting R.oynomologus. (This is rather peculiar as HA has published his results in the USA, in Germany, in France and in Brasil.) R also apparently was unfamiliar with H'S publications regarding the ident- ity of the African and Brazili.sn strains of Yf t<rus. HA says that the infection of monkeys with mosquito feces has definitely been proven and that a monkey is now with fever which was infected with feces on the un- altered skin of the thigh. ( Also HA says that the inoculation of a male mosquito +&ich had been cohabiting with infected female mosquitos has produced fever in a monkey. ) HA reports that the new president of the state of Goyas is interested in getting the RF to aid in the Health Service in that state. I report that there is very little hope of such cooperation until after the yf situation is well in hand.

Receive the accountent*s report on last year's accounts. Everything seems to be in ship shape for the period during which I have been in Charge.

May 30th. Correio reports that the Minister of Justice had a conference 1 f

yesterday with the president of the state of Rio regarding the future of the yellow fever and health services of that state. Results of this if-' .t conference are unknown but are bound to be interesting. I believe that this change in direction of the service in the state of Rio could have been made much more The t?74%o the

p--M. neered in such

offend no one whereas the present transfer is wounding all kinds of sense ibilities end is eliminating Lintz from the picture. Ray it not be pass- ible that our refusal to go in will eventually provide for the elimi.n- ation of CF from the picture as well. This would be unfortunate as we have always found it possible to cooperate with CF.

COrreiO reports further cases at Quatis de Barra Mansas a& says that the last case in CorYntho owuredon May 10th. This is interesting as Dr. Raul Magalhaes was in the office on My 9th and announced that yf was extinguished in Coryntho, the last case having occurred on April 12thlllII

CF shows with pride the new number of the Archives all of which is devoted to yellow fever.

Give personally to CF our first statistical monthly review of the work in north Brasil covering the month of March, CF requests that we furnish him with lists of all cases occurring in Worth Brasil since the first of January 1929.

33 May 31.

Day in the office. JAK to HSS and OCI.

June 1. FFR has authokised our epidemiological studies planned for this

part of Brssil, and also the assignment of JAR to this office for the present.

AAndrade comes to office and reports that Ferreira Pinto is with tbc and &st have leave of absenoe. Decio told AA that he had been offer- three cantos per month by us to go to north Brasil in the yf service but later admits that this is not true. AA says that the tile are beginning to be found and that he is going to be able to show but a small balance. I go over the situation of his service with AA and suggest that he can orgsnise his service to get along with mush less overhead thsn at present by training subordinate personnel to handle the work 'cr"Lat is being done by doctors at the present t5me. AA says that&&@ has issued an&&&atum to the vpresident of the state to the effect that he must be piven a freg

or hi8 e the state

is broke thia oan only ma"an that Lintc is out. CF had the support of both the president and thsvministef~t~~ng a hand in the Rio state

pi+;+*!

. * affairs.uwas the msn sent by SF to DrecD it is probable that he will not remain;U brings the rumour that Sebast- ilo Barroso is to be assigned to duty in lichteroy. I cannot believe that this will cQge to pass as I believe CF is convinced of the need of young active men in the yf 8ervices. AA reports that the President of the state supported the loval authorities againstI&&x in the recent discussions that developed in Quatis de Barra Mansas regarding street fights that had occur- red between the guardas and the population. )N .&t : A'.

Tell Andrade that we can advance no more funds to thejserviee until the contract has been signe& I do however accept his vale for fivehundred milreis.

Discuss with AA the possibilities in the study of yf and malaria in Mag& and he promises to return on June 4th for further discussion.

June 2nd. +fl-.+ y F l&H *"h.L_SJ&rk AA- gA,q JAR and JTA hunt blood all morning without results. I spend morning

in office. John Ellis comes to ht ea.

June 3rd. Day at the office. Only one death reported for DF from yf last

week.

June 4th. To Bichteroy to talk over plans for Rag6 with DP. Decio is giving I/

all available information/ Refuses to tell snything regarding the local situation. Entirely possible that he knows nothing of the future although he does not appear as downcast as in the last interview.

Bleed Pedro Ferrreira Beto, Frei Csneca 525 for the second time. HA has no new dope on the lowal situation. KA offers to let me send bloods to OCI to be worked up into serum by his personnel to whom I shall give a gratification.

MM: wires as follows: From Rata1 June 3: Please discreetly sug- vz

gest that we would favorably consider all Brasil if policia de focos in Federal District was included stop This would leave his service free to practice flitagem and other prophylaxis stop All the work would be under his direction as now stop C@nnor.

4-T ,*iro T-L 4 /‘T 24*Q&&x Y/

r. Oswino’Penna oalls at office to receive copy of Sternberg i article on yellow fever. 7% OP talks quite freely regarding the coming of ’ Kuczinski to OCI. He believes that CCwent to Europe largely to avoid being here during K’S work. Godoy is doing everything possible to help K and has given all materials necessary as well as Dr. Faria who is really working as laboratory 8ervant for K. However Godoy feels the weight of responsibility for sn$thing which K may publish regarding the results of his work in Brazil as this work is being done at the OCIJ OP is sure that Godoy will insist on publishing either that K has succeeded or not in his work and that G will not be willing to leave the matter up in the air/ In other worRs it would appear that G is will ing to do everything possible to help K succeed but is unwilling to let him get by with anything that is not proven. However, should CC return before K finishes his work Uhis entire attitutde may change,

Miss Edith Fraenckel sails for NY to-attend the International COUn- oil of Nurses in Hontrea$i the Correio de Manha laments that someone born within the country could not have been chosen! Shades of Benjamin Consts.ntf!

JAR and I vfsft HSS but %ind little of interest; nothing upstatis.

June 6th. 0 Jomsl nublishes an interview with Sebastiti Barroso in which

the intervention of the DETSP in the State of Rio de Janeiro is defended; SB says in part,

“Antes de mais nada, todo e qualquer serv&(;o contra as doenpas trsnemisrsiveis n&o exclusihente press8 a condiqoes locaea, msx- imfi as oonsideradas epidemioas especialmente as de interferencia inter- national-a peste, o cholera, B unirro#f OS Estados,

a febre smarella- oabe por dever e por dereito se quizerem 8 se 8charem apparelhados, ma8 neste oaso

sob o oontrile da Uniio, podergo asdr essa tarefa, coma interessados mais direct08 no seu desempenho, fioando entretsnto ao poder central a faculdade de ck$ral-a a si qasndo bem o entender. Bass doutrina Consti~CiO~l Z&O soffre hoje a minima ContestapUo desde que levsntada por ti, foi apoilds entre outros or Pedro Lessa, Pires e Albuquerque, Prudente de Moraes Filho e confirmad J em varies pletfos judiciaries por juites singulares 8 at6 por accord&as unsnimes do Supremo Tribunal Federal. Keste oome sm muitos outros cases pelo facto das unidades da Pederavo do serem soberanas a interferenoia do poder central em nada pbde affectar nem me8mo a sua auton- csnia. B&o ha por onde allegar prerogativas num case de”s.cg&o, embora nQo privativa, mas de primazia na hierarchia do8 poderes.

SB caloulates that one third of a yf budget must be spent for material and two thirds for personnel; Kiohteroy with fifteen thousand houses needs a budget of sixtysix contos per month.

uPara tetinar. Ro ultimo accord0 corn a Rockefeller a parte 8111 do paiz fioou exclusivamente entregue ao ‘govemo federal” sem se oogitar da acqilo dos E&ados, porque compete a Uni&o exeoutar taes trsbalhos mu qualquer ponto do territorio naoional."

Dr. Guilherme da Silva calls and discusses the situation regarding yf in the state of Minas. G says that Raul la@hlSes has no confidence in the director of the Centro da Saude in Buiz de Fora; that every-time anything happens in JdeF that either PM, GS, or Emani#go there to direct things. GS spent same six months in Juiz de Fora organizing the yf work after it had been previously organized by the director who knows nothing of yf and the stegcnvyia. Some twenty of the guardas GS trained there are now acting as guardas or guarda chefes in Bello Horizonte; others are on duty in other parts of the state.

YF was first confirmed for Coryntho early in April; GS was sent to C(M- firm the diagnosis and has had charge of the control there since the begin- ning. He found a state of panic existing; everyone who could oonveniently leave the place had gone including the entire Municipal Council. The Pres- ident of the Council, himself a physician, hadbeen among the first to flee. GS found it necessary to assume many of the funotions of governmen t and became temporarily a amall Mussolini; the government sent fifty soldiers to Coryntho and gave GS full authority to carry out whatever measures he thought neoessary for the oontrol of the situation.

25. June 6th Continued.

Work was begun on the fourth or fifth of April; 8.n attempt was made to get rid of all unnecessary oontainers of water and drain all low-lying parts of the city. (GS insists that he ha= bred out stegomyia from dirt ditches.) Policia de focos has been intense since the beginning. Pumigation with sulphur wa8 carried out working from bothe the center and the periphery. Every house in Coryntho has been fumigated, six hundred of the eight hundred hOUSe8 being Plmaigated in the first three weeks of service. The index of breeding reported by the guardas is now less than one; in spite of the low index and the fumigation of all houses a case of yellow fever developed on May the 10th in an individual known to have been infected in Coryntho after a period of 29 days in which no cases were known to have occurred. Medical vigilsnoe has been limited large- ly to 8chOOl children. A total of thirty odd cases 8re known to have occur- red in Coryntho; GS believes however that the first importation of yf was probably in January of this year!

I discuss with GS the work that we would like to do in Coryntho; he shows keen interest for the project and promises all oooperat- ion possible. He says that he is already making plans to secure and ade- quate map of the town and that the Municipio is interested in securing a health center but that prelimiary to the health center a health survey ah should be made. Therefore it seems that our census and his might well be combined and thus the people would be spared double visits and multii21e molestations; also if they remember the fifty pragas whioh he had at his back a few weeks ago there will probably be very little resistance to the idea of giving a little blood to a good cause like ours. GS promises to re- turn to discuss the situation further on June 8 at which time he will know more about the possibilities.of gett ing an adequate mapain the near future.

GS suggests also that Porto Nova should be a good poihtto work for the type of study that we wish to make. He says that four of five deaths are known to have occurred in about ten confirmed cases of the dis- ease. However the practicing physician there says that he had acme eight previous cases that were probably yf so that the total number of known cases may be put at eighteen. The interesting thing about the outbreak at Porto Hove is that the town is in a very narrow valley between the river a and the mountains and has a length of some seven kilometers; it should then be interesting to work out the chronology of various oases aocording to geographical location.

OS insists that he believes that the only service of permanent value is that directed against the breeding of the stegomyia and cites the occurrence of a case in Coryntho where all houses were mgt&ddsnd still infective mosquitoes must have been present.

GSsaysthat Raul MagalMes is now in a very strong position in the state of kInas; that Antonio Carlo8 is strongly behind him and is giming fill support to the entire health movemnnt.

June 7th. Correio carries eulogistic article on School Nurses referring to

the work of Amerfcan nurses in-Brazil. To OCI-find HA and Costa Lima mulling over the problem of excretal

infection in yf. CL is convinced of the importance of this method of trans- mission$ their results so far show that the excreta of infected mosquitoes is infective when inoculated into monkeys; two tests have been made showing that monkeys may be infected through placing excreta of infected mosquitoes on the unbroken skin of the monkeys necks; positive results have also been secured through placing the material in the conjunctiva.

June 8th. 26.

Inform Cl ofoare ofyf removed frazthe Ale An&in0 (Almirante) in Reoife prembly ~19 June 6th. This ship was in Rio froa#ay 9th to r Hay 21, arrived in Bahia On Hay 25 sailing the 88me dpry for Burope. Was

fM.w~*(

not sobeduled to stop in Reoife bpt apparently did so to disembark yf ease. The Alairante Alexendrino was tied up at Armasen 14 in Rio and also dooked at Bahia but for OailJr a f"err hours. CF asks for additional information re- garding the uheruabout8 of the re8idenOe of the patfent in Rio. Also ad- rise CF of Oanfirmaticm of the previously reported surpeOt Oare in Par&i and of M&l's report of rmrrpeated eases ooourring in Pedra and B8a Sorte ia the state of Permmbuoo.

June 9th Sunday.' Spemd day on the beaoh and at 125 Bolilrrrr.

-Wade and Perreira Pinto Oome to the offioe. FP looks well although he is alwap'# 80 thin that a tentative diagnosi8 of tba might be rade at rpy tW without mah Obanae of error) he aakr for 8i0k leave but offers to go to Mag6 with u8 for as muahtime as cb away needs he preriourly worked in l&6 and 8hould be a great help to us there. However, a telegran fru8 his father arriwa oalling him up Oountry beaause of the serious illness of his sister*

(JUMB 8.lU3TBSL6CKIBlGAEOVE.) Andrade says that Lintz him that it had been repooted that the RF

was to take 0-r the yf ServiOe in the state Of Rioi that if strohwere to hap- pen that he personally would not hare opposed the move but that he Oould not J tolerate the idea of permitting CF to take over his servioe on the plea that it was ineffioient whe8x frau the stand point of results it was better o rrps that of CF. Ro news is yet awailable as to the final outcase of the fidtrt;.

tirade asks for money but I refuse until suah time as we have something offioialffm tha atate authorities justifying the expense. AA prumises to ham the needed justification early next week and I prolnise to have funds available on the fifteenth.

Suilherme da Silra frar Co& a&es to the offioe while Andrale is prerent bnt thoughtfully doe8 not i&xude On Our oonversation. AA in8istr that he must some day fight it Out with 88 for the things that were published by him a oouple of years age. CS says that he expeotr to get authorization to spend the neac3rsary funds for the preparation of a good map of CorynthO and praPises fo let me knorr Of devml~nts.

16Bangel says that no important ohanges were made in the manuroript o f BB af%er the first of ParOh-this means that the results of monkey experiment- aticn regarding infeotibility during the period of inOubation oould not have influenoed BB'r rrnaark8 on that point in the M8y number of the Arohivos.

Jlans 11. To Hag6 with JAR and AA. Reraltr prrotioally nil as Dr. Del Negro

was not present. However, we now have a better idea of the place and shall att&pt to return on June 14th at whioh time it should be possible to begin work.

June 12th. Take mail to the llorthern Prinoe and get poor irpresriOn of ship.

Prazires to beoa~e smelly in very short time. Disouss withMrs.BP que8tiaa' of oopie8 of OorrespondenOe b for our files and 8m informed that rhe 58 in no way subordinate to this offiae)$ that Dr. Rose and Dr. VinoaSt rent her TV Braril with instruotionr that she was assigned to the Brazilian govem- men% and that she had never reoeiwd 8ny inetruotionr to the oontrary, etoi f%wthermorethat she s not reoeive her salary through this offlOe but

00. Dr. d&S, JS and I attend the dame at the nurse%

I visit Hanguinh08~ some serious work is being done on ement fixaticw in yf, I diSOU88 possible sources of pure

and deliver to Co&a Lima a copy of Dr. &188ellr'6 letter regarding A. maOuli-?es. HA report8 that lCu0zin8ki has already isolated four

27.

June 12th. continued. viruses frm Brazilian cases of yellow fever and was

wondering how come that HA did not have at least twenty strains going in his laboratory. HA and CL report that in addition to fecal contaminations already noted that they have been able to infect monkeys with yellow fever by the in- jection of emulsified male mosquitos which had been cohabiting with infected females; THEY HAVE NOT YET PROVEN TBE POSSIBILITY OF TRAESMISSIOE FROM SUCH COETAMIEATED KAtES TO VIRGEN FEMALES BUT LAUGHINGLY SUGGEST TH3 POSSISILITY THAT YF MAY BE A VEEEREAL DISEASE OF MOSQUITOES/. Costa Lima insists that the results already secured may be entirely due to fecal contamination of the legs or body of the male frcaz the cage containing infected females.

June 13th. Wire MEC that CF suggested yesterday that it would be better

for him to arrive in Rio either before tier after the Medical congress which convenes June 30th to July 6th. CF says that of oourse he will find some time for MEC whenever he arrives but that unles he expects to remain acme time in Rio, itwoul~ be much better for him to come before or after the Congress.

SUchoa says that he understands that Lintzw..2cl&urn&&c -.tba-S~ts ;l 0-o and is to continue as head of the Propbna Rural and as head of the State Sanitary Service;however, the yellow fever service is to be separ- I/ ated from the Prophlyaxia Rural in this State and will become a special ser- vice as called for in the RF contract. SU gives it as his personal opinion that the situation in Rio could be facilitated greatly if the RF were to tske over the control in that state.

I learn that the Medioal C@%ttee of Congress passed a resolutfon a few days ago extolling the action of the President in the face of the intro- duction of yf into South Brazil last.year ; no mention was made of CF and the point was made at some length that invidious comparisons of the situation today with that of the time fo Oswald0 Cruz were not in order; that is to say the medical committee definitely took exception to CF's propaganda that yf control today is much more diffioult than in the time of OC. ( The ohhiwan of this committee i.6 on@&. Penido from Nuiz de F&a who is said to be decidedly ant- agonistic to CF.)

June 14th To Mag6 with HAN, AA, Memaria and Del Negro; spend the w visit-

ing houses and taking oenaus. Arrange for JAN snd Demaria to return Monday Kfth two guardas to take up the work seriously. From statements made by Bil Negro it 58 clear that Mage was infeoted from other sources by at least three different inditiduals at more or less the same time.

June 15th. Deliver list of vaocinated individuals to HA at Manguinhos and

borrow two thousand slides from Dr. Chaves as there are none available in the local market; Pick up Dr. Costa Cruz who says that the loss of complement in yf cases is very oonstmt early in yellowfwer and is proportional to the severity of the disease ; a prognosis based on the degree of reduction in ocaap- lement is much more certain than one based on clinical findings. The loss of ocxnplement is not constant in moukeys however and in benigh oases msy not be at all noticeable; fatal monkey infections show loss of complement but not as early as do human infections.

June 16th JAN prepares for Mag8.

June 17th Wire from MIX,

Have arranged to sell car ordered for Recife by cablestop Prefer to see Dr. Fraga after July 6th stop I am arriving in Rio on Steamer Andes and plan to remain indefinitely stop Co

Kerr to Magh. 3 or.

Passage has been reserved for J on the Western World sailing from Rio on July 3rd.

June 18th. From 0 Jornal do Brasil,

NO Departamento da Saude Publioa, numa publi.oa@o offioial, aoaba de deolarar, de maneira oategogica, o facto da inexistencia, no Rio, do qualquer doente de febre arnarella. l!!!l!!!!

Last night A Koite reported a case removed from SQo Christ- ovsiol 1 June 19th.

As was to h ave been expected other cases of yf have ooeurred- three are said to have been oonfirmed since ht the premature deolaration of absence of yf from the city.

Our demonstration of difference in lanterns apparently has been successful as the DKSP are plaoing en order for five hundred of the foous- ingtype. Dr. Yaurioio oould not understand how lanterns could be purohased in the local market for less than we uere paying in KY. (I do not know whether he thought we were getting a drag out of it or not.)

Dr. Zenha Ma&ado with whom I had talked last in Curityba in 1921 oalls end lunohes at the office.

Dr. Edison Cavalcanti whcm I last saw in Pernembuco in 1921 oalls looking for work with the yf servioe preferably in Viotoria but is willing to go to the north. He abandoned medioine and hygiene during three or four years to enter into active commerce. However, these are tribulous times and he now needs a steady inoome.

AAndrade repcuts that he had quite a blowup with Lint% on last Saturday. Welladay it is not my fight!

Ferreira Pinto goes to Mag& tomorrow. HA is quite surprised at the number of livers of dead monkeys

that are giving positive cultures of various organisms. HA gives me serum from Iohad Dyares and Pedro Brreira Met-to. Ichad has a slightly positive Wassermann.

Kucxinski is to report before the Academy of Medicine tomorrow evening.

June 20th. Dr. Vi&or Murray of the USPHS now stationed in BA arrives at

offioe and is taken to OCI &d HSS. At HSS two probable oases of yf are seen. Kuczinski delivers a long lecture to the Academy of Medicine in Frenoh. Kerr, Murray and I attend and learn a great deal of French! No details of methods of culture were given neither were any oultures shown. Photos were shown of cultures and of liver sections; the statement was made that infect- ion had been scoured from the twentieth subcultures of his organism, and

to the diagnosis of yellow haraoteristic liver findings1

Godoy and other interested spectators were present! All had the impression that little of importance had been said on the subject of the etiology of yellow fever. After the lecture there was no grand rush to oompliment K on the evenings performance. K felt I believe the hostility of the occasion and oovered up his embarrassment with a rather forced oonversation in English with me. Cl? then joined us and gave K an invitation to show his laboratory and his oultures to CF and to me next week.

$lne 21. Correio reports that K finished his oonference amid a salvo of palmas

end that the president of the Academy said some palavras amaveisoomo 6 de ritualtlll!!!!!!!! Jdg i s in from Mag6 and reports that the work is getting on very well but that Demaria is absolutely worse than nothing at all. As I suspected. Present Dr. Murray to Dr. CF end others of the DKSP

June 22. The Paraguayan Vice Commul appears and requests on behalf of the

Paraguayan Minister to Brazil, Fulgenoio Moreno, en explanation of the depart- ure of the RF from Paraguay which might be transmitted to the Counoil of Hy- giene in Asunoion through the Minister of Foreign affairs.

June 2%. Sunday JAK returns from Yag6.

29.

June 24th Day at the offid.

June 25th Failed to note under dat of June 19th that a bliod sample had been

reoeived from Dr. Raul Magalhaes in Minas from a girl thought to have con- tracted yellow pever in S&o Hypolito which lies between Diemantina and Curvello. This blood was delivered on the seme day to Dr. HA for jmmun- ity test with M.rhesus. HA reports that this monkey has had fever sinoe the seoond day after injeotion and asks for a further sample fromldinas.

June 26th. Spend the day in Magg with JAK and Dellegro working on the

census. Dr. Cotta of the faotory gives us certain interesting informat- ion regarding the "Garcia" family.

June 27&h. 28th. June 27. Deliver cultures from New York to BA.

Visit the Santa Casa for the first time and am introduced by Dr. Amadeu Fialho to Dr. Abreu Fialho, the dean of the medical school and the best eye

speciali$t in the city of Rio. The object of the invitation to visit the Santa Casa was to talk over the possibilities of pulling John D.6 leg for funds to aid the new researoh institute which is being created in the Medical Faculty and in which the younger Fialho is taking a leading part. There is on foot already a grand sohme for research within the school-something almost unknown in Brasil in the past. I took pains to explain oarefully the relationship of the International Health Division to other parts of the Foundation and showed that I had no direct authority in anything related to Medioal Eduoation but stated that I would be very glad to aot as intermed- iary in the submission of their desires to the Foundation. And after all " C&em r&o ohora, nQo mamma!"

Have a long talk with Dr. Arthur Moises who recently published an article in the Archives regarding Fh% - serum di agnosis of yf. I was quite surprised to hear him state that it is his belief that there is no prospect in the near future for the laboratory diagnosis of yellow fever without the use of monkeys at present. Until the virus can be cultured and the effeot of serum studied on cultures he believes that all thought of laboratory

ii diately raise the question of the culture of , , shows plainly what his sentiments are on formation that an attempt had been made

before Guinle was approaohed to get the government to buy a large stock of KS vaocine against yellow fever. The government was approaohed at that time by the German Legation; the government responded that they would accept the vaacine for a trial if K oared to ship out a lot; this ended the dis- cussionl When it was learned that K was to oome to Brazil an attempt was made through diplomatio channels to prevent his oaming for fear of unpleas- ent results; the attitude of the Department of the Ex$erior however was that no official a&ion should be taken in soientificidisoussions and therefore nothing was done. The general desire in Rio at the present time seems to be that K may finish his work here and leave the country without any unpleasant incidents occurring.

Dr. Murray leaves for Sgo Paula. Attempt to visit CF again but find him out a* has been the rule this week.

June 28th Following telegrams received this AMt Bahia 13h 28th Dootor Lewis has bean ill two days stop Temper-

ature now between 102 and 103 stop symptoms so far oan probably be explain- ed by grippe and sinusitus Davis

Bahia 14h 28th There seems no doubt that Doctor Lewis has yellow fever stop inooulated monkey already has fevev stop Lewis has fever 103.8 pulse 80 end two grams albumen per liter Davis.

- 30 -

June 30. MEC arrives on "Andes" from Reoife and reports having touched at sammidnight, Thnrsday, seeing both Dr. Burke and Dr. Davis. Lewis was reported- ill with diagnosis of grippe.

JAK returns from Maje and reports all work there oompleted with the exoeption of seouring ser+n-.. Dr. WdeSA goes with me to meet MC. Weal1 lunoh at the home of Dr. Antunets in Ipanema. Telegram arrives at midday stating that Lewis had 3.8 grms. per litre albuminuria, Saturday. Later telegram states anuria supervened Saturday. New York has been fully advised on Dr. Lewis's oondition.

In the -tend inauguration of the Aoademy of Medioine. The Warners, Mrs. Parsons, and Schoenfeld were in the party. The.most interesting event of the evening was the statement of RS that K had visited the Embassy and asked him to intervene with the RF'. K had explained at some length his difficulties at the Institute but seemed to fear that I am not malleable material. RS assured him that the RF was entirely independent of all oonneotion with the Govermnt of the United States and that there was no possibility of snaking a diplomatio approaoh through him. _

Dr. Miguel Couto presided at the Aoadenry meeting. Paraguay, La Guardia, Argentina by Dr. Speroni and Dr. Sweanvy made the official speeoh for the United States. President Washington Luis was among those present.

My 1; During the forenoon the absenoe of any news from Bahia made us hope against hope that Dr. Lewis's oondition was better. H-ever, just befor\noon a telegram arrived stating that he had died about midnight last night. Hotel.

Lunched quietly with Dr. Araoz# Alfaro and Dr. Conuor at the Gloria Dr. Alfaro disousses quite frankly the Argentine situation and

piotures the a&nation there as rather hopeless. However, his final suggestion is that we persist for a while longer in order to see what turn events may take. MIX and I oall on CF to disouss the situation in the nor-&. MEC makes a strong plea and requests that Dr. Fraga mke a final statement as t ow fever work. This Dr. Fraga promises to do. Dr. Connor and I oall on Dr. Servulo Lima and on Dr. Kauricio Abreu.

It was definitely deoided to-day that Drs. Connor and Kerr should embark for Bahia the day after tomabbow.

A oonferenoe will be held tomorrow with Drs. Fraga and Kuoz ing the latter's 'proposed risit to the laboratory in Bahia. .+y-;@--

believes tha$ such a visit would=very inappropriate acthe present time.

the w' Dr. Connor spent some time in the offioe this morning. In

ernoon I pi&ed him up at the Gloria Hotel at about 4 o'olook and together we went to oall on Fraga and converse with Kuoz is very desirous of working in new quarters.

Kuc'zinski d e He woul like to take the

failing that desires to work in Dr. Connor explains as tactfully

as possible that with Davis none too will the present is not an opportune time for expending invitations to visit Ehe'Bahia laboratory, espeoially in the faoe of the reoent loss of Dr. Lewis. Furthermore, Dr. Connor insists that the laboratory is for diagnostio Durposes only. makes it plaip that they have no

Likewise, Dr. Braga

department. ain the labowutories ow

MEC haves

30-A. Notes on various converstions withMEC end JAK. (clune 29 to lily 3rd 1929.)

wishes work on sera frcxnMag6 to be done in Bahia as he would like to work reported from this field. Agrees to take the matter up with Davis. suggests statistician and more employees for the Rio office. ,A

Janeiro has been a permanent endemic focus which _I- of antimosquito measures in January_of last

s against this hypothesis to no avail.) - -. . in that he is the onlv pub&ic health administrator d fever when all the resources of a-country were -

o fit into his progremme in the North before but rience of working alone in Paraguay that he has is willing for Kerr to return to the yf service

letting the past be forgotten. says that fmrepprts to the north frcvn this office will be appreo-

iated especially regarding the incidenne of yellow fever. -___c_I

i r _..--. -- -eh to enter the State of Rio because& _-- CF told me that he has no faith in fumigation and medical vigil- snce

\ Jensen, Waldemar and Bh$a believe i *Proper personnel is not available.

appe69 ~Ilaaf~~LcBQ1%ric~~ke-!2gehaenihsmObelj &!@sazil inoluding the Federal Dis- trict with its 14!00000 inhabitants end the State of Rio but could not do so for the State of Rio alone!)

he does not believe the RF should mix in State and Federal political soraps. Says that political affiliations change rapidly. (However, this overlooks the question that t @;a,JfiK,e.poould ed by our entry into the Stat

have been entirely avoid- o/ ; also overlooks the advantage that would

oome frm having yf control in the hands of sane permanent organization such as the RF rather th& in the hands of t

he "is more hopefu 3 orary political groups. hen he has ever been regarding the ult- 6/i

imate outcome of the yf campaigns-believes that the State of Rio will clean itself if the Federal District is oleened

mssary lhe experience of OC

y years ago to invade the State of Rio to eliminate foci which were continually reinfecting the Federal Distriot; and this at a time when the popul and with amuch higher percent

if not in fact" 7 i smoothly on to - 'j

dea has worked miraoles already and united the

State the Federal Districtznot included- in the offer of the

of Rio, thus,not -us unx ed control; however, united control already exists. (This in spite of the disruption of the service in the State of Rio for the past two months. InMag6 for exemple the state servioe has been refusing to

[/'

take the measures considered necessary by the local director beoause of the oon- vi&ion that the DNSP will soon take over the work and will reorganize everything. In the meantime the uroblem remains unsettled as to who shati direct the servioe,)

k do not want control ofyf in all Bra&& Now!!!!!!!!!!!!!!~~ - m-e---- MEC oonsiders it entire& unnecessary.

says that the logical P ro re 6 Wilm should be Parahyba, Recife, Bahia, RiodBJaneiro. (This apparently harps baok to MIX's veiled threat of Feb. i9A7 regarding my sue-in this field.)

that wth is used up end has twioe let Fortaleza get away frq him;that he has -no highmtion than to direot the service in Fortaleca; that he shhll not request Smith's return to Brazil following his next leave to the USA.

that -ford h-1 and let Reoife get olear away from him; that C did not wish to go to Parahyba but seems to be satisfied now that he is there;that for scme time he was so despondent that there was every prospect t that he would return to the United States.

30-B.

that Burke is pretty tired and may be unavailable for future service after the present period.

that Muenah seems to be very well satisfied;thatM has rather refused to be convinced of the need of going back to the eight hour day; MEC believes that this has <tome through the influence ofM3s. M. who likes to have M at haane in the after- noons;thatMrs.M classifies as one of the most selfish and selfcentered persons in the worlds thatM is to go on leave sometime next year at which time study leave is to be granted; that heEEC does not expect to ask for his return to this field.

JAK stated on July 2nd that he was glad of the chance to go to the laboratory in Bahia in yellow fever work but that he could not under any oircmstances con- sider taking up administrative work again under MEC; that rather than do so he was determined to resign fran the F@lndation staff. JA.K seems thoroughly worked up emotionally on this point. JAR further discusses the seme question of the following day shortly before sailing for Bahia on the same boat withEC. I in- sist that MEC should be informed of this decision and JAR prcunises to do so on the trip to Bahia; I inform JAR that it will be necessary also for me to send this information to FFR to avoid any future difficulties. ( I have noted oonstant signs of tension between the two during the few days that they have been here together; MEC insisted to Alfred0 that under no circmstanoes should their pass- age be purchased for berths in the same cabin.)

TELE,PHORE 6. M. 2699 AV. RUY BARBOSA 12 FUNDACAO ROCKEFELLER

DIVISAO SANITARIA INTERNACIONAL RIO DE JANEIRO, BRAZIL

CAIXA POSTAL NUMERO 49 ENDEREGO TELEGR. “ROCKFOUND”

July 2. Continued. ‘s15o Paul0 aalled at recent visit to his day at the Hotel. ( -

Dr. Arthur Beiva, Director of the Biological Institute of the offioe today. This oall acanes as a direct result of my Institute in S&o Paul0 and my conversation with him the other It should be remarked in passing that AN had certain diffio-

ulties with LKH @?jl@i~ in the early days of the Foundation work in Brazil and was for Some time the head of opposition to the Foundation in S&o Paulo. AS the years have passed however and the Foundation has become stronger and stronger in the country I believe AR has seen the error of his ways and would long since have been pleased to reestablish friendly relations withthe Foundation. Confident- ial information rates him as en opportunist with no settled likes and dislikes which may not be ohanged for politi6al reasons on the spur of the moment. He is oredited with muoh of the opposition to Dr. Paula Souea at the time Dr. dlio Prestes beoame governor of the state of SfXo Paula. During the recent yf epidem- io in Rio when it seemed impossible that CF would be able to maintain himself in the Department AR was me of the oandidatea most widely quoted for the position of Director. Should Julio Prestes become the next President of Brazil as now seems probablg, either AN or some oandidate of AN's may well take over the position now ocoupied by CF.) In any case there should be no loss in having friendly relations- with AN at the Dresent time in spite of the personal questions of the past.

31

bontrol of lar iroular e&ollin&e v&rtues of fish in the

s insisted that such a-d by \ CF would be of inestimable value in the north were the pernioious propaganda Of &@astiflo Barrosso has been very diffioult to oombat ooming as it has from the department~paganda of the Rational Department of Health. i

JAR and Miss Morse dine at 125 Bolivar but MEC has another previous engagement.

Jul 3. MEG and JAR sail for B@ia. JAR is glad of the opportunity to get into d+rl ow fever laboratory but does not relish the idea of working with Dr. Connor; tells me that he will resign from the Foundation Staff before working direotly under Dr. Connor again. He autho&izes me to inform FFR of his deaision not to work with Connor again but says that he prefers to make suoh decision known to MEC himself rather than having me disouss the situation with&.

July 4th. Dr. Henry C. Sweaney, of the TB Research Bureau of the Municipal TB S rvice in Chicago called at the offioe today. Rush graduate 1921 and is ao- qiainted with GRS. Jerry O'Connell dies shortly after the baseball game at the oountry club.

JS and I lunch with Dr. Pedro Dias at the Gloria; Drs. La Guardia, Rabello, and Rabello,filho, and the sister of Dr. Pedro are present.

Have long oonferenoe with LaGuardia at the office in the afternoon regarding the situation in Paraguay. LG gives many interesting sidelights on reoent seraps among the Asunoion medical profession. LG wishes to seaure fellow- ships for certain of the young men on the faculty but I try to explain to him the difficulty which will be enoountered in getting NY approval for such fellow- ships. LG and I go over the question of our withdrawal very thoroughly and I discuss with him the details of the letter written to the Minister Of Paraguay recently givMg the offioial explanation for suoh withdrawal. Dr. Penha, of Asunoion, who is now studying in Rio de Janeiro aocompsnied LG on his visit to the office.

Day for disoussion of on recent develop

whioh certain results of Davis have been incorporated. HA-explains that this was done to forestall oertain wild claims for priority that may be made by Kuczinski who seems to be inclined to cop off everything available. a paper on the pathology of yellow fever in whioh it is shown that ogy of both the liver end the kidney were thoroughly worked out and published by him in 1922; that the Hoffmann granules were really.described by him and that the Torrea inclusions wm noted by himself. MTqrres who also presented paper takes oexception to this stat&nW..and insi- the inclusions seen

a

and described by him have nothing to do w%th the fragments of degenerated nuclei described by Ii&L. MT also finds it difficult to explain oertain findings of Cowdry and Kitohen in human tisuues since it is believed by HT that the inclus- ions in the liver represent the living virus and the living virus is not to be

32.

July 5. continued. demonstrated by monkey inoculation bf liver tissue fram f t 1 human cases of the disease. On the whole the disoussion 886111s to be dL&ated by MT rather than by HR-L. HA laments the fact that the cultutes of Kucxynski have not been plaoed in the hands of other workers for adequate confirmation of his results. Lemos Montero of Butantan presents two papers both of which merely aonclude that more work must be done!

The entire series of papers to have been presented on different phases of yellow fever control were suppressed at the urgent solicitation of Dr. Fraga \ who desired to avoid all possibility of complications either among Brasilian workers or among the representatives from Buenos Aires and Montevideo.

Kuozinski's presentation of the causative organism of yellow fever occurred at OCI in the afternoon instead of at the Congress in the morning as scheduled. K talked about an hour giving some more information than was available at the meeting at the Acaderny of Medioine including the formula for his special medium and a demonstration of the cultures in the tubes and on microscopic slides. After the lecture, HR-L in a masterly fashinon oalls attention to the need of confirmation of such an important finding and urges the immediate neoessity of distributing cultures to other workers for confirmation; K responds that nothing is so greatly desired by Uself as the confirmation of his workbby adequately prepared scientists and that he is prepared to distfibute oultures at any time. Lutz, who presided at the seesion, took oooasion to Gross question K regarding the yellowfever attaoks of himself and of his assistant. On the whole K spent *mmal quart0 de hors." Notwithstanding the extreme willingness to give cultures manifested by K five minutes previoulgy, he oounterdd Amaral's request for cultures to take to Butantan by the suggestion the Amaral should send a teohnioian to work with himfiune four of five days to learn the special tech&o required for these cuftures. Dr. Godoy and I discuss rather thouroughly K's entire history as known to the tw of us. Following K's demonstration HA gives a demonstration of a 'bonde' of his own which he believes to be the same organ- ism as that of K/ This organism was isolated frcm the liver of a monkey dying a few days after the inoaulation of emulsion of NOW-IWFECTED Stegcanyias.

Penido requests that I secure if possible specimens of Moguohi's trachaa cultures from NY.

July 6. All day at the office. Spend oonsiderable time on the preparation of the ?xanslation into English of the Resume of Lins' article on yellow fever.

Baboocks andMrs. O'Connell sail on UanDyok. Fork arrives with five passengers aboard and

July 8th. Dr. Guerra Blessmann, of the Faculty ofldedieine of Porto Alegre, oeme

to the offioe today with Dr. Carlo8 Pena fis), Federal Deputy fran R io Grande, to sound me out regarding the possibilities of RF assistance to the medical sohool in PA. They both insist that the Sohool is now in a position to go ahead rapid- ly and that the aotion bf the state in eliminating professional liberty will be a strong factor in bringing the sohool rapidly to the frcat.

Discuss the use of fish with WSAninines and SUoh$a; the latter reports that the state of Rio situation is till now\qlithou't solution.

<Jz gry De;EtE;Eui;r5;gs in map oflAag&; it is large scale and appears to have

P-= Visit frcan Dr. Arthur Costa ohief of the yf service in Santos. We zscuss various phases of yf control including the use of fish.

The Minster of Fazenda grants the request of the Minister of the XII- terior that the RF be permitted to go dire& top the Alfandega without going through the two mini&r&es. This represents a rest triumph!

%i%% 126 Bol. Miss Bras11 andMario Pernembuoo and fsmily arrive from NY/ Three MPS

33.

July 11th. continued. Conference with CF. Learn that no roof gutter regu&ation hax yet been made in the DF although CF has repesgedly requested it $ran the prefeitura. I present the known details of the Boa So&e epidemic in the state of Pernmnbuoo; CF aggees that a similar high per%sge o we of the disease in Rio de Janeiro was only avoided through the efforts of the health department.

July 12th. Preparirtion made for trip toMag&.

Jul 13th.Leave Leopoldina Station at 6~30 AM forYag& and spend the day with d-F-- erreira Pinto in the joyous occupation of convincing the inhabitants of the village that they should have their "braqos furados"; the children followed us in swarms frgn one house to another all interested in seeing the bleeding pro- oess; all in all 44 specimens were secured.

0 Jornal says Guayaquil is intensifying its antilarval service because of reported yf in Columbia. +-QP July 14th. Sunday. Prooopio in the afternoon, ohuroh at night.

%v= Dr. J8ELo Py Crespo, Director of Health work in Pelotas calls to ask

a ou process of securing fellowship, Del Regro calls to consult literature; La Fayette de Freitas calls in the interest of fellowship for AggeuMagalMes. LF says oases of yf occurred inMag$ as early as December 1928. RochaLima invited to visit laboratory in Bahia.

July 16. Mag&53 specimens seoured.

Jul 17. Dr. Oswino Penna calls at the office and shows me his publication in the &edica' in whioh the work of Councilman is r-to the.dis- advantage of RochaLima. OP says that he was prbme observations of his own on the pathology of yf when he learned frcsa HA that I had a copy of Sternburg's publication. This he immediately sought and received from me (see entry June 6) and was astounded to see the thoughtfulness and thoroughness of Councilman's work. OP insists that the combination of neorosis and fatty degeneration is the characteristio lesion of yellow fever and that the

1 hasized by HRL is of little importance;, t-on as his work when he made the discovery that the work of C had covered the ground adequately. For the benefit of Brazilian science and Brazil- ian honor he felt impelled to call attention to the work of Councilman and in- terpret that work as antedating by twentytwo years the work of Rooha Lima. He says that he did not consult me regarding the plblication of this work since he did not wish to involve me in previous knowledge and he was determined that the publication must be made. All of this places me in an embarassing position as those who do not know me will be inclined to think that I stimulated the public- ation to detract from the glory of Brazilian Science in favor of a ompatriot. I oall at OCI in the afternoon and request AragEio to explain to RL just how the publication ocourred,'

WSAntunes,to lunch at 12 Av. Ruy Barbosa. Dr. Diniz Gonzaga, whose brother, the professor of chemistry I met in 1921

oalls to leave s-e reprints and establish contact

July 18th Maag& 51 specimens.

fi%sii Request visit of Dr. Lintt to the offioe to straighten out the mis-

ing regafding the note of his secretary critimizing our bank account. Since he is equally responsible, I have no satisfaotory answer when he says that v he is aatisfied that no insult was in nde$.

4i-e Lintz says that he would) would have welcomed the RF to the State to take o9er the yf service but that he did not feel that the record of CF had been such in the past as to justify his procedure in taking over the work by force and leaving all Brazil to under&a&l that the serviceswere being taken over by the DNSP because of the inefficiency of the state servide. He considers that the finsnoial contribution of the RF would in itself be adequate justification

34.

July 19th continued. but that in addition it is recognieed in Basil that the m has a specially trained staff for the handling of the problem. Lintz reports that there were in the State of Rio six cases in the month of June; three in Nichteroy, one in Barra de Pirahy, one in Carmo and one in Valenga. In July two known cases have occurred in Nichteroy.

We agree that the more quickly Andrade is able to render accounting for funds aocording to the accountanoy of the state, the more quickly will all misunderstand- ing be eliminated.

FBageL bleed 57, inoluding a number at the factory. Dr.Motta is in convincing the refractory ones.

July 21. Sunday.

F+ Day at the office toMa.nguinhos in the afternoon. It aould appear e ou tures are going to be given by K to Costa Cruz.

July 23. Yag6- Bleed 74.

iii%?* Dr. Uoh$a calls at offioe to inform us of his appointment to the PR

a e Health Servioe in the state of Cear& to take @he place made vacant by the death of Dr.bemosthenes Carvalho who died suddenly last week fraan a perfor- ated gastrio uloer. SU is acoepting the appointment and is apparently very glad to get away from Rio de 8aneiro. I believe he feels that there is no future for him here; that the appointment of Lawerda to the Maritime service indiaated to him that there was no hope for local preferment without strong politioal baaking; he feels that there is nothing to gain here but 'dor de oabega' and that if he is going to leave that this dull period of yellow fever is the proper time to get. CF told him that he did not like to sre him go but that he might go subject to recall in case of necessity during the cgning months.

Dr.Mattos Galls to consult me about the temperature necessary for t the sterilization of babies feeding bottles at the Arthur Bernardes Hospital; NP told M that I was a specialist in such matters and that she would take my judge- ment before that of anybody else. I told him that I believed that for the purpose- his present equipment, which he says gives about twelve puunds pressure should be sufac5.ent.M is greatly relieved as he did not wish to spend the money on the installation of new apparatus at this time.

Mr. Richard Pattee of Porto Rico called with a letter of introduction Ashford. Dr. Amaral at Butantan gets,a letter ffan me asking to secure the snake sera eta which he will need on his pro-

posed exploration of the Amazon basin. PeryassG calls to ask for a copy ofMosquitoed of America whiah is

being crdered for him. LaFavette de Preitas oalls and asks for anttierpreter to acocanpany

Mrs. Keyes. Jacob Bergstein is suggested for the job.

July 25th. Mag&bleed 75.

office. Amadeu Fialho calls at the office and askes Rat Baoteriology which I promise to secure for him.

He says there has been ho yf in Rio for scsne weeks; the most interesting case seen by him recently was a case of bacillary dysentery ocrmplicated by yf. Gross lesions were only slightly suggestive for yf bgt microscopically the lesions were very characteristia. AF' says that he overheard scxne criticism of me among a group who do not know me personally for my part in the publication of the work of Councilman;AF insists that he told them I was inoapable of having stim- ulated the publioation. I explained the situation fufly to AF but told him that there was nothing to do as any statement would only make the situation worse. AF says that as recently as yesterday the State of Rio problem has not been

July 27th. Bleed 62 atMag6.